MEDICARE: HEATHER MARIE NAUGHTON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2011002565	MO

General Provider Information

NPI Number	:	1083342455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MARIE NAUGHTON LPC

Provider Business Mailing Address
First Line	:	6907 PAGE AVE # 1125
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63133-1507
Country	:	US
Telephone Number	:	314-936-5646
Fax Number	:

Provider Business Practice Location Address
First Line	:	429 COVENTRY TRAIL LN
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-5135
Country	:	US
Telephone Number	:	314-936-5646
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2022
Last Update Date	:	09/19/2022

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