Healthcare Provider Details

I. General information

NPI: 1083114425
Provider Name (Legal Business Name): MRS. HEATHER MARIE FLANNERY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 COURT ST
PORTSMOUTH OH
45662-3932
US

IV. Provider business mailing address

303 GERVAIS RD
FRANKLIN FURNACE OH
45629-8742
US

V. Phone/Fax

Practice location:
  • Phone: 740-354-6685
  • Fax:
Mailing address:
  • Phone: 740-259-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberQMHS
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number160518
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: