Provider Demographics
NPI:1992914394
Name:HARRIS, HEATHER R (MA, LLP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:R
Other - Last Name:HARRIS-HEFFERNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11177 BUNO RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-9202
Mailing Address - Country:US
Mailing Address - Phone:810-333-4310
Mailing Address - Fax:
Practice Address - Street 1:132 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1510
Practice Address - Country:US
Practice Address - Phone:734-489-1182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361006948103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist