Provider Demographics
NPI:1952557043
Name:PHILP, HEATHER LYN (LCSW, CADC II)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYN
Last Name:PHILP
Suffix:
Gender:F
Credentials:LCSW, CADC II
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LYN
Other - Last Name:PHILP-BROWNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADCI, CNA
Mailing Address - Street 1:8495 CRATER LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-3011
Mailing Address - Country:US
Mailing Address - Phone:541-826-2111
Mailing Address - Fax:541-830-3509
Practice Address - Street 1:8495 CRATER LAKE HWY
Practice Address - Street 2:
Practice Address - City:WHITE CITY
Practice Address - State:OR
Practice Address - Zip Code:97503-3011
Practice Address - Country:US
Practice Address - Phone:541-826-2111
Practice Address - Fax:541-830-3509
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
ORL69211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical