Provider Demographics
NPI:1649447939
Name:HEARD, MICHAEL (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HEARD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:HEARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:925 KILLARNEY DR
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1292
Mailing Address - Country:US
Mailing Address - Phone:773-618-2231
Mailing Address - Fax:219-865-7879
Practice Address - Street 1:800 MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1578
Practice Address - Country:US
Practice Address - Phone:847-903-5604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149006014101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health