Provider Demographics
NPI:1093923609
Name:HEERTS, TIMOTHY J (MA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:HEERTS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 S GRACE CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-7226
Mailing Address - Country:US
Mailing Address - Phone:605-371-2405
Mailing Address - Fax:605-335-3282
Practice Address - Street 1:7511 S LOUISE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5951
Practice Address - Country:US
Practice Address - Phone:605-334-5850
Practice Address - Fax:605-335-3282
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC547101YM0800X
SDLMFT1148106H00000X
IA00198106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist