Provider Demographics
NPI:1821438839
Name:HEATH, DANIEL (MASTER LEVEL)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:HEATH
Suffix:
Gender:M
Credentials:MASTER LEVEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 CLARK RD STE 107
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-5558
Mailing Address - Country:US
Mailing Address - Phone:904-765-0665
Mailing Address - Fax:
Practice Address - Street 1:435 CLARK RD STE 408-5
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-8505
Practice Address - Country:US
Practice Address - Phone:904-765-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health