Healthcare Provider Details

I. General information

NPI: 1275263493
Provider Name (Legal Business Name): HEATHER J. CONN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2022
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SOMERVILLE AVE SUITE
CHATTANOOGA TN
37405
US

IV. Provider business mailing address

110 SOMERVILLE AVE
CHATTANOOGA TN
37405
US

V. Phone/Fax

Practice location:
  • Phone: 423-403-5780
  • Fax:
Mailing address:
  • Phone: 423-403-5780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2310
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: