Provider Demographics
NPI:1386849628
Name:HEENAN, JANE (MFT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:HEENAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 N RANCHO DR
Mailing Address - Street 2:#234 STE.12
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3425
Mailing Address - Country:US
Mailing Address - Phone:702-810-4159
Mailing Address - Fax:
Practice Address - Street 1:4343 N RANCHO DR
Practice Address - Street 2:#234, STE. 12
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3425
Practice Address - Country:US
Practice Address - Phone:702-810-4159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00917106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist