Healthcare Provider Details

I. General information

NPI: 1871812230
Provider Name (Legal Business Name): LYNN C. HEPPERLY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 N 16TH ST STE E110
PHOENIX AZ
85016-5124
US

IV. Provider business mailing address

8790 E VIA DE SERENO
SCOTTSDALE AZ
85258-4001
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-2770
  • Fax: 866-534-1701
Mailing address:
  • Phone: 602-628-3449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC-11056
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW-10651
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: