Provider Demographics
NPI:1861962888
Name:DOWNEY, HEATHER FAYE (LCAC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:FAYE
Last Name:DOWNEY
Suffix:
Gender:F
Credentials:LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-2155
Mailing Address - Country:US
Mailing Address - Phone:812-801-3668
Mailing Address - Fax:
Practice Address - Street 1:1405 BEAR ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-1705
Practice Address - Country:US
Practice Address - Phone:812-265-4513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87900007A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN87900007AMedicaid