Provider Demographics
NPI:1457462582
Name:HEYNS, JOHN ROGER (MA LMSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ROGER
Last Name:HEYNS
Suffix:
Gender:M
Credentials:MA LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1703 S DESPELDER ST
Mailing Address - Street 2:PSYCHOLOGICAL SERVICES CENTER LG
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417
Mailing Address - Country:US
Mailing Address - Phone:616-842-1277
Mailing Address - Fax:616-842-4190
Practice Address - Street 1:1703 S DESPELDER ST
Practice Address - Street 2:PSYCHOLOGICAL SERVICES CENTER LG
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417
Practice Address - Country:US
Practice Address - Phone:616-842-1277
Practice Address - Fax:616-842-4190
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010148871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical