Healthcare Provider Details

I. General information

NPI: 1164012589
Provider Name (Legal Business Name): HOLLY CHRISTINE HEUER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11518 N PORT WASHINGTON RD STE 202
MEQUON WI
53092-3443
US

IV. Provider business mailing address

5655 N CRESTWOOD BLVD
MILWAUKEE WI
53209-4351
US

V. Phone/Fax

Practice location:
  • Phone: 262-999-2792
  • Fax:
Mailing address:
  • Phone: 314-359-3738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4850226
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10322-125
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10322-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: