Provider Demographics
NPI:1548317886
Name:HEEREN FAMILY THERAPY
Entity type:Organization
Organization Name:HEEREN FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:BRANTMAN
Authorized Official - Last Name:HEEREN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:231-933-4661
Mailing Address - Street 1:12935 S WEST BAY SHORE DR STE 330
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-6291
Mailing Address - Country:US
Mailing Address - Phone:231-933-4661
Mailing Address - Fax:231-933-4661
Practice Address - Street 1:12935 S WEST BAY SHORE DR STE 330
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-6291
Practice Address - Country:US
Practice Address - Phone:231-933-4661
Practice Address - Fax:231-933-4661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOB81353OtherBLUE CROSS
MIOB81353OtherBLUE CROSS