Provider Demographics
NPI:1336936194
Name:WATERWALL, HEATHER (LCSW-S)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:WATERWALL
Suffix:
Gender:
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12007 BLOOMINGTON LN
Mailing Address - Street 2:
Mailing Address - City:MEADOWS PLACE
Mailing Address - State:TX
Mailing Address - Zip Code:77477-1819
Mailing Address - Country:US
Mailing Address - Phone:832-524-4255
Mailing Address - Fax:
Practice Address - Street 1:2021 GUADALUPE ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-5654
Practice Address - Country:US
Practice Address - Phone:646-941-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX621821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical