Provider Demographics
NPI:1134643174
Name:HEIDELBERGER, HENRY
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:HEIDELBERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23070
Mailing Address - Street 2:
Mailing Address - City:BARLING
Mailing Address - State:AR
Mailing Address - Zip Code:72923-0070
Mailing Address - Country:US
Mailing Address - Phone:479-452-5040
Mailing Address - Fax:479-452-5047
Practice Address - Street 1:1422 CALDWELL ST STE B
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-5319
Practice Address - Country:US
Practice Address - Phone:501-500-4892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARF1707005101YM0800X
106H00000X
ARM2010013106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health