Healthcare Provider Details

I. General information

NPI: 1366682957
Provider Name (Legal Business Name): HEATHER L SIMS M.A., LPC, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER L BECKER

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 S 108TH ST
GREENFIELD WI
53228-2505
US

IV. Provider business mailing address

4420 S 108TH ST
GREENFIELD WI
53228-2505
US

V. Phone/Fax

Practice location:
  • Phone: 414-383-4486
  • Fax: 414-235-3453
Mailing address:
  • Phone: 414-383-4486
  • Fax: 414-235-3453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15652-132
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4840-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: