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General NPI Number Information
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NPI Number | 1669031860
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Entity Type | Individual
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Provider Name | GARY ANTHONY HEIM LLP
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Gender | Male
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 5311 RAINBOW RIDGE CT NE
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City | ROCKFORD
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State | MI
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Zip | 49341-8116
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Country | US
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Telephone | 616-558-2399
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Fax |
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Provider Business Mailing Address
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Address Line | 5311 RAINBOW RIDGE CT NE
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City | ROCKFORD
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State | MI
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Zip | 49341-8116
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6301007384
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License Number State | MI
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