MEDICARE: MRS. GRETE ANTONIA HEATHERLY LPCC-S

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	101YP2500X	Professional Counselor	E.1100472-SUPV	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295007409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRETE ANTONIA HEATHERLY LPCC-S

Provider Business Mailing Address
First Line	:	625 CLEVELAND AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44702-1805
Country	:	US
Telephone Number	:	330-455-0374
Fax Number	:	330-453-6716

Provider Business Practice Location Address
First Line	:	1207 W STATE ST STE M
Second Line	:
City	:	ALLIANCE
State	:	OH
Zip	:	44601-4686
Country	:	US
Telephone Number	:	330-821-8407
Fax Number	:	330-821-8506

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

Provider Enumeration Date	:	02/02/2012
Last Update Date	:	12/01/2025

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