Provider Demographics
NPI:1912767146
Name:SYLVESTER, HEATHER LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:SYLVESTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E HAWKINS PKWY APT 504
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-3662
Mailing Address - Country:US
Mailing Address - Phone:512-789-9632
Mailing Address - Fax:
Practice Address - Street 1:814 GILMER RD STE 1
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-3614
Practice Address - Country:US
Practice Address - Phone:903-806-6123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1035811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical