Provider Demographics
NPI:1790977940
Name:SHEALY, HEATH O'BRYAN (LAC)
Entity Type:Individual
Prefix:
First Name:HEATH
Middle Name:O'BRYAN
Last Name:SHEALY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6502 E CARONDELET DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2117
Mailing Address - Country:US
Mailing Address - Phone:520-488-8741
Mailing Address - Fax:
Practice Address - Street 1:6502 E CARONDELET DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2117
Practice Address - Country:US
Practice Address - Phone:520-505-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AZLAC-012167171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health