Provider Demographics
NPI:1588960082
Name:CONNELLY, HEATHER SUE (MA, LPCA, LMFTA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:SUE
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:MA, LPCA, LMFTA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:SUE
Other - Last Name:HAMRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14205 N MO PAC EXPY STE 570
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-6529
Mailing Address - Country:US
Mailing Address - Phone:512-348-6226
Mailing Address - Fax:
Practice Address - Street 1:14205 N MO PAC EXPY STE 570
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-6529
Practice Address - Country:US
Practice Address - Phone:512-348-6226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX97045101YM0800X
WAMG60227200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist