Provider Demographics
NPI:1871502104
Name:HEISKELL, THOMAS L (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:HEISKELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 29TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2231
Mailing Address - Country:US
Mailing Address - Phone:740-353-3464
Mailing Address - Fax:
Practice Address - Street 1:806 6TH ST
Practice Address - Street 2:SUITE 312
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4158
Practice Address - Country:US
Practice Address - Phone:740-353-5033
Practice Address - Fax:740-353-5033
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3163103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical