MEDICARE: DR. HEATHER MARSHALL PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	103TC0700X	Clinical Psychologist	071.011009	IL
3	103TC0700X	Clinical Psychologist	PY12754	FL

General Provider Information

NPI Number	:	1568080299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER MARSHALL PHD

Provider Business Mailing Address
First Line	:	2450 TIM GAMBLE PL STE 240
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4384
Country	:	US
Telephone Number	:	708-789-9539
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 TIM GAMBLE PL STE 240
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4384
Country	:	US
Telephone Number	:	708-789-9539
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2020
Last Update Date	:	12/09/2025

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Directions to “ DR. HEATHER MARSHALL PHD” Practice Location

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