MEDICARE: HEATHER M JARVIS MS, LCMHC

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	068.0104740	VT

General Provider Information

NPI Number	:	1437911393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER M JARVIS MS, LCMHC

Provider Business Mailing Address
First Line	:	140 W SHORE RD
Second Line	:
City	:	GRAND ISLE
State	:	VT
Zip	:	05458-2103
Country	:	US
Telephone Number	:	802-355-1110
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 W SHORE RD
Second Line	:
City	:	GRAND ISLE
State	:	VT
Zip	:	05458-2103
Country	:	US
Telephone Number	:	802-355-1110
Fax Number	:

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

Provider Enumeration Date	:	01/26/2024
Last Update Date	:	01/26/2024

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