Provider Demographics
NPI:1285767913
Name:TUSTISON, HEATHER SUE (LCPC)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:SUE
Last Name:TUSTISON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:SUE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2176 E FRANKLIN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8009
Mailing Address - Country:US
Mailing Address - Phone:208-869-0199
Mailing Address - Fax:208-908-6164
Practice Address - Street 1:2176 E FRANKLIN RD STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8009
Practice Address - Country:US
Practice Address - Phone:208-869-0199
Practice Address - Fax:208-908-6164
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-4258101Y00000X, 101YM0800X, 101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral