Provider Demographics
NPI:1538858006
Name:CARROLL, HEATHER M (MED)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:SEABURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:2929 FM 2920 RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-3428
Mailing Address - Country:US
Mailing Address - Phone:281-210-1500
Mailing Address - Fax:
Practice Address - Street 1:2929 FM 2920 RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3428
Practice Address - Country:US
Practice Address - Phone:281-210-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician