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General NPI Number Information
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NPI Number | 1548709306
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Entity Type | Organization
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Legal Business Name | GARTH HEASLEY LLC
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 1943 W 5TH AVE
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City | COLUMBUS
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State | OH
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Zip | 43212-1902
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Country | US
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Telephone | 614-477-8257
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Fax |
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Provider Business Mailing Address
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Address Line | 297 RAVINE RIDGE DR N
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City | POWELL
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State | OH
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Zip | 43065-9352
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Country | US
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Telephone | 614-477-8257
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GARTH HEASLEY
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Credential | LISW
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Telephone | 614-477-8257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1700034
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License Number State | OH
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