MEDICARE: HEOREON AN LPC

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	PC019041	PA

General Provider Information

NPI Number	:	1770463929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEOREON AN LPC

Provider Business Mailing Address
First Line	:	2011 KIMBALL ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-2622
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1517 WALNUT ST # 202
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3001
Country	:	US
Telephone Number	:	215-642-8968
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2025
Last Update Date	:	10/24/2025

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Directions to “ HEOREON AN LPC” Practice Location

Language	Start Address	Practice Location

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