Healthcare Provider Details

I. General information

NPI: 1659774321
Provider Name (Legal Business Name): HARRY H HEYER LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 PLANTATION WAY
LAFAYETTE IN
47909-6821
US

IV. Provider business mailing address

333 PLANTATION WAY
LAFAYETTE IN
47909-6821
US

V. Phone/Fax

Practice location:
  • Phone: 765-586-6030
  • Fax:
Mailing address:
  • Phone: 765-586-6030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number33006831A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number33006831A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: