=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093150211
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER L. WILCOXON LCMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2013
-----------------------------------------------------
Last Update Date | 07/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 122 PLEASANT ST
-----------------------------------------------------
City | CLAREMONT
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03743-2679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-542-5449
-----------------------------------------------------
Fax | 603-542-5455
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 HANOVER ST SUITE 2
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03766-1312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-448-0126
-----------------------------------------------------
Fax | 603-448-6001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 982
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH 11325
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------