Provider Demographics
NPI:1588390983
Name:HEATH, MARIE (MS, LPC)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:HEATH
Suffix:
Gender:
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 TEAK ST
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6313
Mailing Address - Country:US
Mailing Address - Phone:605-484-0489
Mailing Address - Fax:
Practice Address - Street 1:107 E 1ST ST
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3801
Practice Address - Country:US
Practice Address - Phone:307-228-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-1367101YP2500X
WYLPC-2373101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional