Individual
MATT HEATHERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
8492 ENCLAVE BLVD, FISHERS, IN 46038-1591
(317) 721-4123
Mailing address
8492 ENCLAVE BLVD, FISHERS, IN 46038-1591
(317) 721-4123
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100270530A
—
IN
Enumeration date
12/19/2006
Last updated
05/14/2012
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