Provider Demographics
NPI:1700116399
Name:HEILVEIL, IRA PAUL (PHD)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:PAUL
Last Name:HEILVEIL
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 1:308 N MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2746
Mailing Address - Country:US
Mailing Address - Phone:888-909-8741
Mailing Address - Fax:
Practice Address - Street 1:308 N MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2746
Practice Address - Country:US
Practice Address - Phone:888-909-8741
Practice Address - Fax:888-909-8741
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBA-273103K00000X
CA1-10-6815103K00000X
MNLP5323103T00000X
NM1048103T00000X
CAPSY7726103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY077260Medicaid
CAIHCP7726Medicare PIN
CAPSY077260Medicaid