Provider Demographics
NPI:1952738601
Name:HELLER, MARTIN THATCHER
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:THATCHER
Last Name:HELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MARTIN
Other - Middle Name:THATCHER
Other - Last Name:HELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9220 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1032
Mailing Address - Country:US
Mailing Address - Phone:727-209-0895
Mailing Address - Fax:727-209-0449
Practice Address - Street 1:9220 102ND AVE
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777-1032
Practice Address - Country:US
Practice Address - Phone:727-209-0895
Practice Address - Fax:727-209-0449
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor