Provider Demographics
NPI:1811495252
Name:GOTCHER, HEATHER ELIZABETH (MED)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:GOTCHER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:390 UNION BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-6514
Mailing Address - Country:US
Mailing Address - Phone:720-439-7878
Mailing Address - Fax:303-984-4366
Practice Address - Street 1:4504 LEGACY DR STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2182
Practice Address - Country:US
Practice Address - Phone:720-439-7878
Practice Address - Fax:303-984-4366
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1962103K00000X
TX11830400103K00000X
TX1-18-30400103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst