Provider Demographics
NPI:1467438929
Name:HESLOP, MERRILL R (LCSW)
Entity Type:Individual
Prefix:
First Name:MERRILL
Middle Name:R
Last Name:HESLOP
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20185 E OCOTILLO RD
Mailing Address - Street 2:#105
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242-8799
Mailing Address - Country:US
Mailing Address - Phone:480-987-2700
Mailing Address - Fax:480-987-2703
Practice Address - Street 1:20185 E OCOTILLO RD
Practice Address - Street 2:#105
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242-8799
Practice Address - Country:US
Practice Address - Phone:480-987-2700
Practice Address - Fax:480-987-2703
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-28171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ105613Medicare ID - Type Unspecified