Healthcare Provider Details

I. General information

NPI: 1114202215
Provider Name (Legal Business Name): CHARLES K HEES PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 WILLIAMSON COUNTY PKWY
MARION IL
62959-5235
US

IV. Provider business mailing address

3111 WILLIAMSON COUNTY PARKWAY
MARION IL
62959
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-3647
  • Fax: 618-969-9437
Mailing address:
  • Phone: 618-997-3647
  • Fax: 618-969-9437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: