Provider Demographics
NPI:1689003147
Name:HEATHERLY, JOE III (LPC)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:
Last Name:HEATHERLY
Suffix:III
Gender:
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:PO BOX 1131
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602-1131
Mailing Address - Country:US
Mailing Address - Phone:870-204-6016
Mailing Address - Fax:870-782-2914
Practice Address - Street 1:716 S PINE ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-5830
Practice Address - Country:US
Practice Address - Phone:870-204-6016
Practice Address - Fax:870-782-2914
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2107009101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199054795Medicaid