Healthcare Provider Details

I. General information

NPI: 1326465238
Provider Name (Legal Business Name): HEATHER TREE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 NW 31ST TER
GAINESVILLE FL
32605-2178
US

IV. Provider business mailing address

3525 NW 31ST TER
GAINESVILLE FL
32605-2178
US

V. Phone/Fax

Practice location:
  • Phone: 352-377-0147
  • Fax:
Mailing address:
  • Phone: 352-377-0147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2195
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2195
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2195
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: