Provider Demographics
NPI:1255172466
Name:HEATON, ROBIN LEIGH (CT)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:LEIGH
Last Name:HEATON
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-3340
Mailing Address - Country:US
Mailing Address - Phone:801-598-2348
Mailing Address - Fax:
Practice Address - Street 1:65 SAINT FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-3413
Practice Address - Country:US
Practice Address - Phone:567-220-7018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2405542-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty