Provider Demographics
NPI:1962790998
Name:LETTOW, HEATHER NICOLE (MA,, LPC, LMFT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICOLE
Last Name:LETTOW
Suffix:
Gender:F
Credentials:MA,, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-1558
Mailing Address - Country:US
Mailing Address - Phone:269-269-7437
Mailing Address - Fax:269-382-0866
Practice Address - Street 1:5104 LOVERS LN
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1558
Practice Address - Country:US
Practice Address - Phone:269-269-7437
Practice Address - Fax:269-382-0866
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006492106H00000X
MI6401012485101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist