Provider Demographics
NPI:1720479124
Name:BREIMAYER, HEATHER
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BREIMAYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 W ST JOE HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4093
Mailing Address - Country:US
Mailing Address - Phone:517-323-4099
Mailing Address - Fax:
Practice Address - Street 1:5123 W ST JOE HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4093
Practice Address - Country:US
Practice Address - Phone:517-323-4099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-07
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014692101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional