| Dr Richard Heise Llc | |
|
111 W Port Plz Ste 600 Saint Louis MO 63146-3015 | |
| (314) 399-9707 | |
| (314) 474-0119 |
| Full Name | Dr Richard Heise Llc |
|---|---|
| Speciality | Psychologist |
| Location | 111 W Port Plz Ste 600, Saint Louis, Missouri |
| Authorized Official Name and Position | Richard Allen Heise (PHD) |
| Authorized Official Contact | 6367300596 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Richard Heise Llc 111 W Port Plz Ste 600 Saint Louis MO 63146-3015 Ph: (314) 399-9707 | Dr Richard Heise Llc 111 W Port Plz Ste 600 Saint Louis MO 63146-3015 Ph: (314) 399-9707 |
| NPI Number | 1629600085 |
|---|---|
| Provider Enumeration Date | 02/04/2020 |
| Last Update Date | 09/06/2023 |
| Certification Date | 05/02/2023 |
| Medicare PECOS PAC ID | 8325476971 |
|---|---|
| Medicare Enrollment ID | O20200316000195 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629600085 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Richard Allen Heise |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396773065 PECOS PAC ID: 7012048457 Enrollment ID: I20100628001052 |
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