Heath, Gary D

Heath, Gary D is an individual health care provider with primary practice located at 12970 W Bluemound Rd Suite 105, Elm Grove WI 53122-2607. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Heath, Gary D can be contacted via phone (262) 787-2904.

Contact Information

Primary practice address
12970 W Bluemound Rd Suite 105 Elm Grove WI 53122-2607
Phone: (262) 787-2904
Fax: (262) 787-2909
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 2027-123 Wisconsin
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 339-124 Wisconsin

Profile Details

NPI number 1104981653
LBN Legal business name Heath, Gary D
Credentials LCSW, LMFT
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 26th, 2006
Last updated Jul 9th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104981653 NPPES
Wisconsin MEDICAID 40955300

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