Healthcare Provider Details

I. General information

NPI: 1275697369
Provider Name (Legal Business Name): JOHN GABRIEL HEGER PSY.S LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 S MAIN ST
PLYMOUTH MI
48170-2253
US

IV. Provider business mailing address

10839 CHARRING CROSS CIR
WHITMORE LAKE MI
48189-9100
US

V. Phone/Fax

Practice location:
  • Phone: 734-451-3440
  • Fax: 734-451-8720
Mailing address:
  • Phone: 734-223-3284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361007168
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: