Provider Demographics
NPI:1720620636
Name:HECKLER INTEGRATIVE PSYCHIATRIC CARE
Entity Type:Organization
Organization Name:HECKLER INTEGRATIVE PSYCHIATRIC CARE
Other - Org Name:THE CENTER OF MINDFUL HEALING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:HECKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-972-7855
Mailing Address - Street 1:700 SLEATER KINNEY RD SE STE B-169
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1150
Mailing Address - Country:US
Mailing Address - Phone:360-972-7855
Mailing Address - Fax:360-282-1095
Practice Address - Street 1:921 LAKERIDGE WAY SW STE 102
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6081
Practice Address - Country:US
Practice Address - Phone:360-972-7855
Practice Address - Fax:360-282-1095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty