Provider Demographics
NPI:1841763166
Name:HEINRICH, MELISSA THERESE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:THERESE
Last Name:HEINRICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 FERNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2150
Mailing Address - Country:US
Mailing Address - Phone:248-330-5569
Mailing Address - Fax:
Practice Address - Street 1:1011 W MAPLE ST STE 150
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-5805
Practice Address - Country:US
Practice Address - Phone:269-224-2559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018379103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical