Provider Demographics
NPI:1154575306
Name:HEINLEN, KATHLEEN T (PHD, PCC-S)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:T
Last Name:HEINLEN
Suffix:
Gender:F
Credentials:PHD, PCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20525 CENTER RIDGE RD STE 501
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3435
Mailing Address - Country:US
Mailing Address - Phone:440-333-2106
Mailing Address - Fax:
Practice Address - Street 1:20525 CENTER RIDGE RD STE 501
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3435
Practice Address - Country:US
Practice Address - Phone:440-333-2106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0004360101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional