Provider Demographics
NPI:1144736075
Name:NICHOLE TURNBOW HEIDELBACH, PSYD, LLC
Entity type:Organization
Organization Name:NICHOLE TURNBOW HEIDELBACH, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIDELBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-534-1189
Mailing Address - Street 1:2366 WHITESBURG DR SW STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3830
Mailing Address - Country:US
Mailing Address - Phone:256-534-1189
Mailing Address - Fax:256-533-3076
Practice Address - Street 1:2366 WHITESBURG DR SW STE A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3830
Practice Address - Country:US
Practice Address - Phone:256-534-1189
Practice Address - Fax:256-533-3076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1780261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)