Provider Demographics
NPI:1255102935
Name:FORYS, HEATHER (PLPC, NCC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:FORYS
Suffix:
Gender:F
Credentials:PLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HIGHLAND CT
Mailing Address - Street 2:
Mailing Address - City:DITTMER
Mailing Address - State:MO
Mailing Address - Zip Code:63023-1724
Mailing Address - Country:US
Mailing Address - Phone:636-399-8139
Mailing Address - Fax:
Practice Address - Street 1:8135 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-2821
Practice Address - Country:US
Practice Address - Phone:636-399-8139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023004840101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty