MEDICARE: JENNIFER LOUISE HEINZ LPC

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	6401013008	MI
2	101YP2500X	Professional Counselor
3	101YP2500X	Professional Counselor	6401013008	MI

General Provider Information

NPI Number	:	1568713501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LOUISE HEINZ LPC

Provider Business Mailing Address
First Line	:	2640 LOON LAKE RD
Second Line	:
City	:	WIXOM
State	:	MI
Zip	:	48393-1248
Country	:	US
Telephone Number	:	989-293-3452
Fax Number	:

Provider Business Practice Location Address
First Line	:	2640 LOON LAKE RD
Second Line	:
City	:	WIXOM
State	:	MI
Zip	:	48393-1248
Country	:	US
Telephone Number	:	989-293-3452
Fax Number	:

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

Provider Enumeration Date	:	10/01/2012
Last Update Date	:	08/16/2023

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