Provider Demographics
NPI:1346817731
Name:MACERA, MICHELLE HEFFNER (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:HEFFNER
Last Name:MACERA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 WILSHIRE WAY APT 4114
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-0264
Mailing Address - Country:US
Mailing Address - Phone:469-783-3545
Mailing Address - Fax:
Practice Address - Street 1:5601 DEMOCRACY DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3687
Practice Address - Country:US
Practice Address - Phone:940-765-9029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-05
Last Update Date:2023-07-13
Deactivation Date:2021-07-14
Deactivation Code:
Reactivation Date:2023-07-13
Provider Licenses
StateLicense IDTaxonomies
NVPY0549103T00000X
TX38918103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist