Provider Demographics
NPI:1700051026
Name:HEIKES SULLIVAN, JANET A (MS)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:A
Last Name:HEIKES SULLIVAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:A
Other - Last Name:HEIKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:810 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-5753
Mailing Address - Country:US
Mailing Address - Phone:847-946-2795
Mailing Address - Fax:
Practice Address - Street 1:5900 MEMORIAL DR
Practice Address - Street 2:216-C
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-8004
Practice Address - Country:US
Practice Address - Phone:847-946-2795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005834101YP2500X
TX73428101YP2500X
MNLP 2357103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist