Provider Demographics
NPI:1669781951
Name:BAXTER, HEATHER W (LPC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:W
Last Name:BAXTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-2913
Mailing Address - Country:US
Mailing Address - Phone:870-336-6450
Mailing Address - Fax:949-695-3327
Practice Address - Street 1:323 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-2913
Practice Address - Country:US
Practice Address - Phone:870-336-6450
Practice Address - Fax:949-695-3327
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP19060821041C0700X
ARA1012132101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty