Provider Demographics
NPI:1992856793
Name:HEISLER, JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:HEISLER
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 1:4515 SOUTHLAKE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3319
Mailing Address - Country:US
Mailing Address - Phone:205-313-7246
Mailing Address - Fax:205-939-1911
Practice Address - Street 1:4515 SOUTHLAKE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-3319
Practice Address - Country:US
Practice Address - Phone:205-313-7246
Practice Address - Fax:205-939-1911
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1372103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
167883900OtherUS DEPT OF LABOR
AL051532520OtherBCBS AL
AL051532520OtherBCBS AL
ALQ66323Medicare UPIN