Provider Demographics
NPI:1063793040
Name:HARRISON, HEATHER L (LPC)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:L
Last Name:HARRISON
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 1:617 HILLTOP LN
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-7534
Mailing Address - Country:US
Mailing Address - Phone:918-636-6663
Mailing Address - Fax:
Practice Address - Street 1:229 W GENTRY AVE
Practice Address - Street 2:
Practice Address - City:CHECOTAH
Practice Address - State:OK
Practice Address - Zip Code:74426-2439
Practice Address - Country:US
Practice Address - Phone:918-473-1575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4138101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100745880Medicaid