Provider Demographics
NPI:1750077202
Name:HEIMER, TIA MARIE (MA, LPCC)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:MARIE
Last Name:HEIMER
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:MARIE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:3150 EXCELSIOR BLVD APT 201
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4628
Mailing Address - Country:US
Mailing Address - Phone:612-715-3175
Mailing Address - Fax:
Practice Address - Street 1:4444 CENTERVILLE RD STE 235
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55127-3712
Practice Address - Country:US
Practice Address - Phone:651-289-3111
Practice Address - Fax:651-289-3113
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3738101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional