Provider Demographics
NPI:1043826043
Name:O'FARRELL, HEATHER MARIE (MA, LLPC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:O'FARRELL
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 ASHMAN ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4484
Mailing Address - Country:US
Mailing Address - Phone:989-633-9600
Mailing Address - Fax:
Practice Address - Street 1:2801 ASHMAN ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4484
Practice Address - Country:US
Practice Address - Phone:989-633-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018651101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional