Provider Demographics
NPI:1821236746
Name:HEISS, MARY DENISE (MED)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:DENISE
Last Name:HEISS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS
Mailing Address - State:AZ
Mailing Address - Zip Code:86046-2327
Mailing Address - Country:US
Mailing Address - Phone:928-635-4474
Mailing Address - Fax:928-635-2796
Practice Address - Street 1:440 S 7TH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMS
Practice Address - State:AZ
Practice Address - Zip Code:86046-2327
Practice Address - Country:US
Practice Address - Phone:928-635-4474
Practice Address - Fax:928-635-2796
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool