MEDICARE: YVONNE L HEIM LPC, LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	10979	TX
2	101YP2500X	Professional Counselor	72546	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10979	OTHER	TX	LICENSED CHEMICAL DEPENDENCY COUNSELOR
2	72546	OTHER	TX	LICENSED PROFESSIONAL COUNSELOR

General Provider Information

NPI Number	:	1760695308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE L HEIM LPC, LCDC

Provider Business Mailing Address
First Line	:	104 ROUNDUP DR
Second Line	:
City	:	CASTLE HILLS
State	:	TX
Zip	:	78213-2309
Country	:	US
Telephone Number	:	830-481-6333
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 ROUNDUP DR
Second Line	:
City	:	CASTLE HILLS
State	:	TX
Zip	:	78213-2309
Country	:	US
Telephone Number	:	830-481-6333
Fax Number	:

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/06/2016

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