Provider Demographics
NPI:1669085254
Name:WOLF, HEATHER MARIE (LCPC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:WOLF
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 COLLEGE AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2264
Mailing Address - Country:US
Mailing Address - Phone:773-727-7321
Mailing Address - Fax:
Practice Address - Street 1:429 COLLEGE AVE APT 301
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2264
Practice Address - Country:US
Practice Address - Phone:773-727-7321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012752101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.012752OtherWILL BE PROVIDING DIGITAL THERAPY (TELEHEALTH) FOR BETTERHELP ONLINE THERAPY