Provider Demographics
NPI:1770508368
Name:HEITLAND, WILLIAM CARL (EDD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CARL
Last Name:HEITLAND
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 MASTERS RD
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-9067
Mailing Address - Country:US
Mailing Address - Phone:580-399-6124
Mailing Address - Fax:580-332-7114
Practice Address - Street 1:2601 MASTERS RD
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-9067
Practice Address - Country:US
Practice Address - Phone:580-399-6124
Practice Address - Fax:580-332-7114
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK408103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist