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General NPI Number Information
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NPI Number | 1700465432
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Entity Type | Organization
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Legal Business Name | SOUTHERN PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 04/08/2021
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 4333 HWY 16 S STE 400
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City | BANDERA
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State | TX
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Zip | 78003-5167
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Country | US
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Telephone | 830-264-8210
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Fax |
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Provider Business Mailing Address
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Address Line | 4333 HWY 16 S STE 400
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City | BANDERA
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State | TX
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Zip | 78003-5167
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Country | US
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Telephone | 830-264-8210
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEANIE HEIDELBERG
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Credential | PMHNP
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Telephone | 830-264-8210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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