Provider Demographics
NPI:1861292567
Name:LINDSTROM, HEATHER RACHELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:RACHELLE
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4152 SLICK ROCK CHASE
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-8525
Mailing Address - Country:US
Mailing Address - Phone:972-921-8123
Mailing Address - Fax:
Practice Address - Street 1:4152 SLICK ROCK CHASE
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-8525
Practice Address - Country:US
Practice Address - Phone:972-921-8123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional