Provider Demographics
NPI:1003242710
Name:HECKLER, DAVID ROBERT (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ROBERT
Last Name:HECKLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 RIO GRANDE ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1137
Mailing Address - Country:US
Mailing Address - Phone:512-324-8960
Mailing Address - Fax:
Practice Address - Street 1:1600 W 38TH ST STE 212
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6405
Practice Address - Country:US
Practice Address - Phone:512-324-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36512103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX335907701Medicaid
TX331815YKYMMedicare PIN
TX335907701Medicaid