Provider Demographics
NPI:1477103083
Name:DR HEATHER D HAGGERTY PSYD LP
Entity Type:Organization
Organization Name:DR HEATHER D HAGGERTY PSYD LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAGGERTY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD LP
Authorized Official - Phone:248-346-4999
Mailing Address - Street 1:PO BOX 760096
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-0096
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:340 N MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1290
Practice Address - Country:US
Practice Address - Phone:248-346-4999
Practice Address - Fax:734-335-3931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty