Provider Demographics
NPI:1467883587
Name:HECKENDORN CONSULTATION AND THERAPY, PLLC
Entity Type:Organization
Organization Name:HECKENDORN CONSULTATION AND THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:TRINA
Authorized Official - Last Name:HECKENDORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-274-0536
Mailing Address - Street 1:220 COLLINGWOOD ST STE 140
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3842
Mailing Address - Country:US
Mailing Address - Phone:734-274-0536
Mailing Address - Fax:734-527-6184
Practice Address - Street 1:220 COLLINGWOOD ST STE 140
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3842
Practice Address - Country:US
Practice Address - Phone:734-274-0536
Practice Address - Fax:734-527-6184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-30
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty