Provider Demographics
NPI:1659315745
Name:HEISEL, JAMES IRVING (LISW LICDC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:IRVING
Last Name:HEISEL
Suffix:
Gender:M
Credentials:LISW LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10921 REED HARTMAN HWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-2830
Mailing Address - Country:US
Mailing Address - Phone:513-794-1667
Mailing Address - Fax:513-794-0933
Practice Address - Street 1:10921 REED HARTMAN HWY
Practice Address - Street 2:SUITE 206
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-2830
Practice Address - Country:US
Practice Address - Phone:513-794-1667
Practice Address - Fax:513-794-0933
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH841108101YA0400X
OHI00004721041C0700X
KYKY-10341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000019145Medicare UPIN