Provider Demographics
NPI:1982141776
Name:OTOOLE, HEIDI (LPC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:OTOOLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 HIGH STREET
Mailing Address - Street 2:SUITE 720
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-5415
Mailing Address - Country:US
Mailing Address - Phone:304-413-0426
Mailing Address - Fax:304-413-0427
Practice Address - Street 1:235 HIGH STREET
Practice Address - Street 2:SUITE 720
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-413-0426
Practice Address - Fax:304-413-0427
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health