Provider Demographics
NPI:1598029589
Name:HEISE, VIOLET (PHD)
Entity Type:Individual
Prefix:DR
First Name:VIOLET
Middle Name:
Last Name:HEISE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 N TUCSON BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-4745
Mailing Address - Country:US
Mailing Address - Phone:520-325-4837
Mailing Address - Fax:520-323-3739
Practice Address - Street 1:430 N TUCSON BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-4745
Practice Address - Country:US
Practice Address - Phone:520-325-4837
Practice Address - Fax:520-323-3739
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4254103TC0700X, 103T00000X, 103TB0200X, 103TC1900X, 103TP2701X, 103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging