MEDICARE: ANGELA HEINZMAN LMHC

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	39002201A	IN

General Provider Information

NPI Number	:	1568867570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA HEINZMAN LMHC

Provider Business Mailing Address
First Line	:	5660 CAITO DR
Second Line	:	BUILDING 3 - SUITE 120
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1372
Country	:	US
Telephone Number	:	317-775-8050
Fax Number	:	317-377-3103

Provider Business Practice Location Address
First Line	:	5660 CAITO DR
Second Line	:	BUILDING 3 - SUITE 120
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1372
Country	:	US
Telephone Number	:	317-775-8050
Fax Number	:	317-377-3103

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

Provider Enumeration Date	:	11/03/2014
Last Update Date	:	11/03/2014

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