Basic Information
| Provider Information | |||||||||
| NPI: | 1790058857 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEIMANN | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | VINCENT | ||||||||
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| Credential: | B.A., B.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4885 ASTER ST | ||||||||
| Address2: | APT 10 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974786695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5209757928 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1790 W LLTH AVE. | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416862688 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2012 | ||||||||
| LastUpdateDate: | 02/20/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.