Provider Demographics
NPI:1629600085
Name:DR RICHARD HEISE LLC
Entity Type:Organization
Organization Name:DR RICHARD HEISE LLC
Other - Org Name:DR RICHARD HEISE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHD
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HEISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-730-0596
Mailing Address - Street 1:111 W PORT PLZ STE 600
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3015
Mailing Address - Country:US
Mailing Address - Phone:314-399-9707
Mailing Address - Fax:314-474-0119
Practice Address - Street 1:111 W PORT PLZ STE 600
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3015
Practice Address - Country:US
Practice Address - Phone:314-399-9707
Practice Address - Fax:314-474-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty