Healthcare Provider Details

I. General information

NPI: 1689959629
Provider Name (Legal Business Name): CHARITY HEGGLUND M.A., L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 LAMAR ST STE 440
WICHITA FALLS TX
76301-6837
US

IV. Provider business mailing address

710 LAMAR ST STE 440
WICHITA FALLS TX
76301-6837
US

V. Phone/Fax

Practice location:
  • Phone: 940-867-7650
  • Fax:
Mailing address:
  • Phone: 940-867-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number69440
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number23514
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: