Provider Demographics
NPI:1972693182
Name:HEFFLER, DAVID GLENN (MENTAL HEALTH COUNSE)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GLENN
Last Name:HEFFLER
Suffix:
Gender:M
Credentials:MENTAL HEALTH COUNSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MARKET STREET
Mailing Address - Street 2:SUITE 230 BEWLEY BLDG
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094
Mailing Address - Country:US
Mailing Address - Phone:716-625-9550
Mailing Address - Fax:716-433-7846
Practice Address - Street 1:20 MARKET STREET
Practice Address - Street 2:230 BEWLEY BLDG
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094
Practice Address - Country:US
Practice Address - Phone:716-625-9550
Practice Address - Fax:716-433-7846
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0032911101YA0400X, 101YM0800X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic