Basic Information
| Provider Information | |||||||||
| NPI: | 1275697369 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEGER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | GABRIEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PSY.S LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10839 CHARRING CROSS CIR | ||||||||
| Address2: | |||||||||
| City: | WHITMORE LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481899100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342233284 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1308 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481702253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344513440 | ||||||||
| FaxNumber: | 7344518720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 07/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 6361007168 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.