Healthcare Provider Details

I. General information

NPI: 1154905883
Provider Name (Legal Business Name): HEATHER BRIANNE TRUELOVE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 RESEARCH CT # 125
SUWANEE GA
30024-6606
US

IV. Provider business mailing address

5275 WILL WHEELER RD
MURRAYVILLE GA
30564-1401
US

V. Phone/Fax

Practice location:
  • Phone: 404-941-6201
  • Fax:
Mailing address:
  • Phone: 678-897-7413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA000662
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: