Provider Demographics
NPI:1568925212
Name:HEARN, ROBERT JAY (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JAY
Last Name:HEARN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1699
Mailing Address - Country:US
Mailing Address - Phone:706-649-6500
Mailing Address - Fax:706-649-6521
Practice Address - Street 1:2022 15TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1699
Practice Address - Country:US
Practice Address - Phone:706-649-6500
Practice Address - Fax:706-649-6521
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001407106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist