Provider Demographics
NPI:1588499552
Name:NELLETT, HEATHER LYNN (LMSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:NELLETT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-0142
Mailing Address - Country:US
Mailing Address - Phone:989-385-0801
Mailing Address - Fax:
Practice Address - Street 1:220 N 3RD ST
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-2512
Practice Address - Country:US
Practice Address - Phone:989-385-0801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-07
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011181291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical