Provider Demographics
NPI:1700465432
Name:SOUTHERN PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:SOUTHERN PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIDELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:830-264-8210
Mailing Address - Street 1:234 W BANDERA RD # 204
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2805
Mailing Address - Country:US
Mailing Address - Phone:830-264-8210
Mailing Address - Fax:
Practice Address - Street 1:234 W BANDERA RD # 204
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2805
Practice Address - Country:US
Practice Address - Phone:830-264-8210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-08
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty