Provider Demographics
NPI:1912508516
Name:WARD, HEATHER LANE (LMFT - PROVISIONAL)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LANE
Last Name:WARD
Suffix:
Gender:F
Credentials:LMFT - PROVISIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-1118
Mailing Address - Country:US
Mailing Address - Phone:304-865-0272
Mailing Address - Fax:304-865-0265
Practice Address - Street 1:3705 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1118
Practice Address - Country:US
Practice Address - Phone:304-865-0272
Practice Address - Fax:304-865-0265
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPROVISIONAL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV02OtherPROVISIONAL LMFT