Provider Demographics
NPI:1912532052
Name:LACKEY, HEATHER DAWN (LMHC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:LACKEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:DAWN
Other - Last Name:DEVINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:QUEMADO
Mailing Address - State:NM
Mailing Address - Zip Code:87829-0033
Mailing Address - Country:US
Mailing Address - Phone:575-937-0772
Mailing Address - Fax:
Practice Address - Street 1:1609 N SWAN ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-6551
Practice Address - Country:US
Practice Address - Phone:575-956-6370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0209511101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health