Healthcare Provider Details

I. General information

NPI: 1750416673
Provider Name (Legal Business Name): MERRIL HESLOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 N IRONWOOD DR 110
APACHE JUNCTION AZ
85220-3830
US

IV. Provider business mailing address

288 N IRONWOOD DR 110
APACHE JUNCTION AZ
85220-3830
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-2356
  • Fax:
Mailing address:
  • Phone: 480-982-2356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. MERRILL HESLOP
Title or Position: PRESIDENT
Credential: LCSW
Phone: 480-982-2356