Provider Demographics
NPI:1811146996
Name:HEINTZ, CAROL EVELYN (TLLP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:EVELYN
Last Name:HEINTZ
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 S ROSE ST
Mailing Address - Street 2:SUITE 601 B COMERICA BUILDING
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-4792
Mailing Address - Country:US
Mailing Address - Phone:269-365-4029
Mailing Address - Fax:
Practice Address - Street 1:151 S ROSE ST
Practice Address - Street 2:SUITE 601 B COMERICA BUILDING
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4792
Practice Address - Country:US
Practice Address - Phone:269-365-4029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013868103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist