Provider Demographics
NPI:1861062739
Name:MATHESON, HEATHER (LAC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MATHESON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2815 FALCON KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2423
Mailing Address - Country:US
Mailing Address - Phone:281-731-7494
Mailing Address - Fax:832-772-4517
Practice Address - Street 1:21707 KINGSLAND BLVD STE 104
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2519
Practice Address - Country:US
Practice Address - Phone:832-321-3288
Practice Address - Fax:832-722-4517
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAC01893171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist