Provider Demographics
NPI:1689245912
Name:HEINLE, IAN PATRICK
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:PATRICK
Last Name:HEINLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 S CORONA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3238
Mailing Address - Country:US
Mailing Address - Phone:703-509-9252
Mailing Address - Fax:
Practice Address - Street 1:1776 S CORONA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3238
Practice Address - Country:US
Practice Address - Phone:703-509-9252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZGP831996400OtherBCBS TEXAS