Healthcare Provider Details

I. General information

NPI: 1083923700
Provider Name (Legal Business Name): SABRINA M HEEREN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 E ERIE STREET
CONNERSVILLE IN
47331-0000
US

IV. Provider business mailing address

720 N MARR RD
COLUMBUS IN
47201-6660
US

V. Phone/Fax

Practice location:
  • Phone: 765-825-4124
  • Fax: 765-825-3649
Mailing address:
  • Phone: 812-314-3400
  • Fax: 812-378-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: