Healthcare Provider Details

I. General information

NPI: 1194343145
Provider Name (Legal Business Name): MRS. LIANE HEIVLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 RIDGE RD
SPRING CITY PA
19475-2209
US

IV. Provider business mailing address

211 RIDGE RD
SPRING CITY PA
19475-2209
US

V. Phone/Fax

Practice location:
  • Phone: 631-972-4271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC015845
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: