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General NPI Number Information
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NPI Number | 1679511794
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Entity Type | Individual
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Provider Name | DR. HEATHER DENISE BREITER
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Gender | Female
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 02/19/2010
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Provider Practice Location Address
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Address Line | 2129 SKYLINE DR
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City | FORT WORTH
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State | TX
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Zip | 76114-1924
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Country | US
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Telephone | 800-257-8715
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Fax | 800-819-1655
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Provider Business Mailing Address
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Address Line | 6824 GLEN MEADOW DR
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City | FORT WORTH
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State | TX
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Zip | 76132-3734
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Country | US
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Telephone | 817-370-8644
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 31825
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License Number State | TX
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