Provider Demographics
NPI:1982917746
Name:ANNIS, HEATHER FAYE (MS, LPC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:FAYE
Last Name:ANNIS
Suffix:
Gender:F
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 1:8012 NBU
Mailing Address - Street 2:1211 BRUNSON
Mailing Address - City:PRAGUE
Mailing Address - State:OK
Mailing Address - Zip Code:74864-4044
Mailing Address - Country:US
Mailing Address - Phone:405-567-2649
Mailing Address - Fax:
Practice Address - Street 1:8012 NBU
Practice Address - Street 2:1211 BRUNSON
Practice Address - City:PRAGUE
Practice Address - State:OK
Practice Address - Zip Code:74864-4044
Practice Address - Country:US
Practice Address - Phone:405-567-2649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3390101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional