Provider Demographics
NPI:1730431156
Name:MICHAEL HEARD
Entity type:Organization
Organization Name:MICHAEL HEARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:HEARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-316-8275
Mailing Address - Street 1:8643 S. MARSHFIELD STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620
Mailing Address - Country:US
Mailing Address - Phone:773-239-8463
Mailing Address - Fax:
Practice Address - Street 1:8643 S MARSHFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-4846
Practice Address - Country:US
Practice Address - Phone:773-239-8463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.006014101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty