Provider Demographics
NPI:1679671887
Name:HEINZ PSYCHOLOGICAL SERVICES LTD SC
Entity Type:Organization
Organization Name:HEINZ PSYCHOLOGICAL SERVICES LTD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARLAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HEINZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:715-834-3171
Mailing Address - Street 1:826 S HASTINGS WAY
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3426
Mailing Address - Country:US
Mailing Address - Phone:715-834-3171
Mailing Address - Fax:715-834-3174
Practice Address - Street 1:826 S HASTINGS WAY
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3426
Practice Address - Country:US
Practice Address - Phone:715-834-3171
Practice Address - Fax:715-834-3174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42156200Medicaid