Provider Demographics
NPI:1194493775
Name:HEATHER KLECKINGER LLC
Entity type:Organization
Organization Name:HEATHER KLECKINGER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KLECKINGER-CRAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:318-465-4801
Mailing Address - Street 1:PO BOX 5971
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71171-5971
Mailing Address - Country:US
Mailing Address - Phone:318-465-4801
Mailing Address - Fax:
Practice Address - Street 1:3018 OLD MINDEN RD STE 1205C
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2476
Practice Address - Country:US
Practice Address - Phone:318-465-4801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health