Provider Demographics
NPI:1073894069
Name:HEILEMANN, JEREMIAH P (TBS)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:P
Last Name:HEILEMANN
Suffix:
Gender:M
Credentials:TBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 VINEYARD CREEK DR
Mailing Address - Street 2:#264
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-9002
Mailing Address - Country:US
Mailing Address - Phone:603-315-4507
Mailing Address - Fax:
Practice Address - Street 1:350 E GOBBI ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5511
Practice Address - Country:US
Practice Address - Phone:707-472-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor