Provider Demographics
NPI:1295177236
Name:DOLL, HEATHER DANIELLE (PLMHP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:DANIELLE
Last Name:DOLL
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 N 117TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3670
Mailing Address - Country:US
Mailing Address - Phone:402-934-1617
Mailing Address - Fax:
Practice Address - Street 1:2126 N 117TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3670
Practice Address - Country:US
Practice Address - Phone:402-934-1617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11084101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty