Provider Demographics
NPI:1881775021
Name:HEATON-LAMP, DEBRA (MFT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:HEATON-LAMP
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 IDAHO STREET
Mailing Address - Street 2:SUITE 217
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801
Mailing Address - Country:US
Mailing Address - Phone:775-778-9202
Mailing Address - Fax:
Practice Address - Street 1:405 IDAHO STREET
Practice Address - Street 2:SUITE 217
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801
Practice Address - Country:US
Practice Address - Phone:775-778-9202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMFT 0613106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVA002OtherSUB ID # FOR TRICARE