Provider Demographics
NPI:1902300072
Name:HUNTSMAN, HEATHER RENEE (LMSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:HUNTSMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 W ANIMAS ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5987
Mailing Address - Country:US
Mailing Address - Phone:505-327-0002
Mailing Address - Fax:
Practice Address - Street 1:608 W ANIMAS ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5987
Practice Address - Country:US
Practice Address - Phone:505-327-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-090911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical