Healthcare Provider Details

I. General information

NPI: 1013243054
Provider Name (Legal Business Name): HEATHER NICOL FECTEAU MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8196 WALNUT HILL LN STE 120
DALLAS TX
75231-7007
US

IV. Provider business mailing address

7403 AUTHON DR
DALLAS TX
75248-3023
US

V. Phone/Fax

Practice location:
  • Phone: 214-345-6625
  • Fax:
Mailing address:
  • Phone: 251-232-6992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: