Provider Demographics
NPI:1306543574
Name:FOX, HEATHER D (LAC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
Last Name:FOX
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:D
Other - Last Name:MEEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 S ARKANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-6732
Mailing Address - Country:US
Mailing Address - Phone:479-567-5800
Mailing Address - Fax:479-567-5801
Practice Address - Street 1:1001 S ARKANSAS AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-6732
Practice Address - Country:US
Practice Address - Phone:479-567-5800
Practice Address - Fax:479-567-5801
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ARA2509014101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR305731795Medicaid