Provider Demographics
NPI:1740551233
Name:HOLDER, HEATHER L (PSYD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:HOLDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8627 CINNAMON CREEK DR STE 601
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1482
Mailing Address - Country:US
Mailing Address - Phone:210-722-3576
Mailing Address - Fax:
Practice Address - Street 1:8627 CINNAMON CREEK DR STE 601
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1482
Practice Address - Country:US
Practice Address - Phone:210-722-3576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33855103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic