Provider Demographics
NPI:1174669428
Name:HEINZMAN, JUDITH KAY (RN LPC)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:KAY
Last Name:HEINZMAN
Suffix:
Gender:F
Credentials:RN LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 SAINT LUKES DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7109
Mailing Address - Country:US
Mailing Address - Phone:334-409-9242
Mailing Address - Fax:334-409-7308
Practice Address - Street 1:315 ST LUKES DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117
Practice Address - Country:US
Practice Address - Phone:334-409-9242
Practice Address - Fax:334-409-9163
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1452101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51500916OtherBC FED
AL51099445OtherAMERICAN BEHAVIORAL