Provider Demographics
NPI:1215989082
Name:HEFFER, LANCE R (PSYD)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:R
Last Name:HEFFER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CRANES ROOST CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3650
Mailing Address - Country:US
Mailing Address - Phone:270-765-2605
Mailing Address - Fax:270-766-1222
Practice Address - Street 1:1311 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2621
Practice Address - Country:US
Practice Address - Phone:270-769-1304
Practice Address - Fax:270-234-8028
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0643103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY378700OtherTRICARE
KY30605018Medicaid
KY000000393575OtherANTHEM
KY0358727Medicare ID - Type UnspecifiedMEDICARE
KY0358929Medicare ID - Type UnspecifiedMEDICARE
KY0358830Medicare ID - Type UnspecifiedMEDICARE
KY0358601Medicare ID - Type UnspecifiedMEDICARE
KY30605018Medicaid
KY0026643Medicare ID - Type Unspecified
KYR36950Medicare UPIN
KY378700OtherTRICARE