Healthcare Provider Details

I. General information

NPI: 1710801329
Provider Name (Legal Business Name): HEATHER ANNELISE NOULIS LPC-MHSP, MPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 S ELLSWORTH RD
MESA AZ
85212-2730
US

IV. Provider business mailing address

9722 S 45TH AVE
LAVEEN AZ
85339-2099
US

V. Phone/Fax

Practice location:
  • Phone: 480-780-0211
  • Fax:
Mailing address:
  • Phone: 631-745-4618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5995
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-24276
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: