Provider Demographics
NPI:1679780068
Name:HEATH, STEVEN R (MA IMFT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:R
Last Name:HEATH
Suffix:
Gender:M
Credentials:MA IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:44047-0092
Mailing Address - Country:US
Mailing Address - Phone:440-228-1511
Mailing Address - Fax:
Practice Address - Street 1:145 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:44047-1420
Practice Address - Country:US
Practice Address - Phone:440-228-1511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF079106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist