Provider Demographics
NPI:1548999410
Name:CARRIZALES, HEATHER LOUISE (CADC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LOUISE
Last Name:CARRIZALES
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 S MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-5722
Mailing Address - Country:US
Mailing Address - Phone:208-854-9758
Mailing Address - Fax:
Practice Address - Street 1:524 S 9TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-5072
Practice Address - Country:US
Practice Address - Phone:208-854-9758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCADC-5032101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)