Provider Demographics
NPI:1386433225
Name:METHVIN, HEIDI JOY (LAC)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:JOY
Last Name:METHVIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:J
Other - Last Name:METHVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC,CRC
Mailing Address - Street 1:4200 S 48TH ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-5251
Mailing Address - Country:US
Mailing Address - Phone:213-446-0011
Mailing Address - Fax:
Practice Address - Street 1:2525 W NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1351
Practice Address - Country:US
Practice Address - Phone:479-366-5136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2502016101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health