Provider Demographics
NPI:1699065318
Name:WALL, HEATHER A (LIMHP, LMHP, LADC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:WALL
Suffix:
Gender:F
Credentials:LIMHP, LMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10625 CALHOUN RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68112-1324
Mailing Address - Country:US
Mailing Address - Phone:402-457-1362
Mailing Address - Fax:402-457-1406
Practice Address - Street 1:10625 CALHOUN RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68112-1324
Practice Address - Country:US
Practice Address - Phone:402-457-1362
Practice Address - Fax:402-457-1406
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional