Healthcare Provider Details

I. General information

NPI: 1568725604
Provider Name (Legal Business Name): ZACHARY N HEFFNER MSW, QMHP, CADC II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 SW ACADEMY ST
DALLAS OR
97338-1996
US

IV. Provider business mailing address

182 SW ACADEMY ST
DALLAS OR
97338-1996
US

V. Phone/Fax

Practice location:
  • Phone: 928-950-3623
  • Fax:
Mailing address:
  • Phone: 503-623-1888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number10-12-19
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: