Provider Demographics
NPI:1780447912
Name:KEGGINS-LEWIS, HEATHER
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:KEGGINS-LEWIS
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 1:3584 HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:CHILTON
Mailing Address - State:TX
Mailing Address - Zip Code:76632-3032
Mailing Address - Country:US
Mailing Address - Phone:254-265-2437
Mailing Address - Fax:
Practice Address - Street 1:4209 W WACO DR STE 4
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7111
Practice Address - Country:US
Practice Address - Phone:254-265-2437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000000000000103TC0700X
TX106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist