Provider Demographics
NPI:1366784621
Name:THIEL, HEATHER ELISABETH HYDRICK (LMT)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ELISABETH HYDRICK
Last Name:THIEL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3843 SE 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1716
Mailing Address - Country:US
Mailing Address - Phone:503-777-9099
Mailing Address - Fax:
Practice Address - Street 1:7200 SENECA FALLS LOOP
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-2215
Practice Address - Country:US
Practice Address - Phone:512-399-3310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX691861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical