Healthcare Provider Details

I. General information

NPI: 1437911393
Provider Name (Legal Business Name): HEATHER M JARVIS MS, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W SHORE RD
GRAND ISLE VT
05458-2103
US

IV. Provider business mailing address

140 W SHORE RD
GRAND ISLE VT
05458-2103
US

V. Phone/Fax

Practice location:
  • Phone: 802-355-1110
  • Fax:
Mailing address:
  • Phone: 802-355-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0104740
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: