Provider Demographics
NPI:1235152901
Name:HEATHERTON, BRIAN FRANCIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:FRANCIS
Last Name:HEATHERTON
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:PSYCHIATRIC ASSOCIATES OF CENTRAL ILLINOIS
Mailing Address - Street 2:1124 S. SIXTH STREET
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703
Mailing Address - Country:US
Mailing Address - Phone:217-523-3143
Mailing Address - Fax:217-523-7695
Practice Address - Street 1:PSYCHIATRIC ASSOCIATES OF CENTRAL ILLINOIS
Practice Address - Street 2:1124 S. SIXTH STREET
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703
Practice Address - Country:US
Practice Address - Phone:217-523-3143
Practice Address - Fax:217-523-7695
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.006614103TC0700X
IL071006614101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
05732028OtherBLUE CROSS BLUE SHIELD
05732028OtherBLUE CROSS BLUE SHIELD
K08026Medicare ID - Type Unspecified