Provider Demographics
NPI:1316341670
Name:RISK, HEATHER MICHELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MICHELLE
Last Name:RISK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 E MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40507-1330
Mailing Address - Country:US
Mailing Address - Phone:859-303-8041
Mailing Address - Fax:859-303-8041
Practice Address - Street 1:249 E MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40507-1330
Practice Address - Country:US
Practice Address - Phone:859-303-8041
Practice Address - Fax:859-303-8041
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1557103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical