Healthcare Provider Details

I. General information

NPI: 1255856449
Provider Name (Legal Business Name): HEATHER MICHELLE LYNN AGNEW MS, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 ABRAMS RD STE 325
RICHARDSON TX
75081-5579
US

IV. Provider business mailing address

1110 KATHY LN
LEWISVILLE TX
75067-4359
US

V. Phone/Fax

Practice location:
  • Phone: 972-638-7199
  • Fax:
Mailing address:
  • Phone: 214-460-0357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number73793
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: