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General NPI Number Information
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NPI Number | 1629600085
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Entity Type | Organization
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Legal Business Name | DR RICHARD HEISE LLC
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Dates
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Enumeration Date | 02/04/2020
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 111 W PORT PLZ STE 600
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City | SAINT LOUIS
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State | MO
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Zip | 63146-3015
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Country | US
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Telephone | 314-399-9707
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Fax | 314-474-0119
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Provider Business Mailing Address
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Address Line | 111 W PORT PLZ STE 600
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City | SAINT LOUIS
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State | MO
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Zip | 63146-3015
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Country | US
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Telephone | 314-399-9707
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Fax | 314-474-0119
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Authorized Official
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Title or Position | PHD
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Name | RICHARD ALLEN HEISE
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Credential |
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Telephone | 636-730-0596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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