Provider Information for 1891211066
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HEATHER REBECCA PANTALONE LMSW
Sex: Female
NPI: 1891211066
Last Updated: 2018-03-17
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1891211066 | ||||||||||||
| Enumeration Date | 2017-08-18 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 3309 VINEYARD TRL HARKER HEIGHTS, TX 76548-8847 United States Phone: 254-415-8466 | Fax: | ||||||||||||
| Primary Practice Address | 2401 S 31ST ST TEMPLE, TX 76508-0001 United States Phone: 254-415-8466 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 3309 VINEYARD TRL | ||||||||||||
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