Basic Information
| Provider Information | |||||||||
| NPI: | 1285712588 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUNTER | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | DAVIS | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1026 WARWICK PL | ||||||||
| Address2: | |||||||||
| City: | SOUTHAVEN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386719412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6625364591 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 413 W TYLER AVE | ||||||||
| Address2: | |||||||||
| City: | WEST MEMPHIS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723014149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707331200 | ||||||||
| FaxNumber: | 8707323269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 10/16/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A0110053 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.