MEDICARE: HEIB LIFE THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1396354460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEIB LIFE THERAPY

Provider Business Mailing Address
First Line	:	2854 JOHNSON FERRY RD STE 200
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-5699
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2854 JOHNSON FERRY RD STE 200
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-5699
Country	:	US
Telephone Number	:	678-386-8568
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RACHAEL MEGAN HEIB
Credential	:
Telephone Number	:	678-386-8568

Provider Enumeration Date	:	07/24/2020
Last Update Date	:	07/24/2020

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Directions to “HEIB LIFE THERAPY ” Practice Location

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