Individual
DR. HEATHER DENISE BREITER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2129 SKYLINE DR, FORT WORTH, TX 76114-1924
(800) 257-8715
(800) 819-1655
Mailing address
6824 GLEN MEADOW DR, FORT WORTH, TX 76132-3734
(817) 370-8644
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
31825
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167469901
—
TX
01
—
86932A
BLUE CROSS BLUE SHIELD
TX
01
—
P00163676
RAIL ROAD
TX
Enumeration date
06/02/2006
Last updated
02/19/2010
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