Provider Demographics
NPI:1447887872
Name:BRENNER, HEATHER (LPC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BRENNER
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:KERSHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:590 MEDICAL CENTER LANE
Mailing Address - Street 2:
Mailing Address - City:FORT CAVAZOS
Mailing Address - State:TX
Mailing Address - Zip Code:76544-4752
Mailing Address - Country:US
Mailing Address - Phone:254-287-1866
Mailing Address - Fax:
Practice Address - Street 1:590 MEDICAL CENTER LANE
Practice Address - Street 2:
Practice Address - City:FORT CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544-4752
Practice Address - Country:US
Practice Address - Phone:254-287-1866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80162104100000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker