Provider Demographics
NPI:1336627629
Name:PEREA, HEATHER ANN (BS, AS, LAC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:PEREA
Suffix:
Gender:F
Credentials:BS, AS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 657
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59103-0657
Mailing Address - Country:US
Mailing Address - Phone:406-294-9609
Mailing Address - Fax:406-245-4886
Practice Address - Street 1:1001 S 27TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-4517
Practice Address - Country:US
Practice Address - Phone:406-294-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-30183101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT101YA0400XMedicaid