Provider Demographics
NPI:1215724380
Name:JANDEBEUR, HEATHER ANN (LAC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:JANDEBEUR
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 BRAITHWAITE ST # A
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4643
Mailing Address - Country:US
Mailing Address - Phone:479-553-9226
Mailing Address - Fax:
Practice Address - Street 1:605 BRAITHWAITE ST # A
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4643
Practice Address - Country:US
Practice Address - Phone:479-553-9226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health