Provider Demographics
NPI:1811568942
Name:HEELAN, THOMAS DANIEL
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DANIEL
Last Name:HEELAN
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 1:127 S 37TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1502
Mailing Address - Country:US
Mailing Address - Phone:402-476-2300
Mailing Address - Fax:402-476-2337
Practice Address - Street 1:127 S 37TH ST STE B
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-1502
Practice Address - Country:US
Practice Address - Phone:402-476-2300
Practice Address - Fax:402-476-2337
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1698101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)