Provider Demographics
NPI:1053487157
Name:HECK, DOUGLAS GENE (PHD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:GENE
Last Name:HECK
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 1:205 W 2ND ST
Mailing Address - Street 2:SUITE 437 DULUTH PSYCHOLOGICAL CLINIC
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802
Mailing Address - Country:US
Mailing Address - Phone:218-722-2005
Mailing Address - Fax:218-727-3000
Practice Address - Street 1:205 W 2ND ST
Practice Address - Street 2:SUITE 437 DULUTH PSYCHOLOGICAL CLINIC
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802
Practice Address - Country:US
Practice Address - Phone:218-722-2005
Practice Address - Fax:218-727-3000
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1240103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical