Provider Demographics
NPI:1205899697
Name:HECKER, KATHLEEN MAUCERI (ED D)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MAUCERI
Last Name:HECKER
Suffix:
Gender:F
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:G5
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759
Mailing Address - Country:US
Mailing Address - Phone:512-345-3400
Mailing Address - Fax:512-346-1923
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD
Practice Address - Street 2:G5
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:512-345-3400
Practice Address - Fax:512-346-1923
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21239103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00TN500Medicare ID - Type Unspecified