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General NPI Number Information
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NPI Number | 1477085439
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Entity Type | Individual
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Provider Name | HEATHER PROCTOR LMHC
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Gender | Female
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 2571 N TOLEDO BLADE BLVD UNIT 3
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City | NORTH PORT
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State | FL
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Zip | 34289
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Country | US
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Telephone | 941-276-6716
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Fax |
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Provider Business Mailing Address
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Address Line | 2571 N TOLEDO BLADE BLVD UNIT 3
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City | NORTH PORT
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State | FL
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Zip | 34289-9351
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Country | US
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Telephone | 941-276-6716
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Fax | 941-234-0208
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH13422
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License Number State | FL
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