Provider Demographics
NPI:1306276654
Name:HEISE, NELSON (MS, PCC, LICDC-CS)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:HEISE
Suffix:
Gender:M
Credentials:MS, PCC, LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1546
Mailing Address - Country:US
Mailing Address - Phone:614-257-3760
Mailing Address - Fax:614-257-3150
Practice Address - Street 1:1492 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1546
Practice Address - Country:US
Practice Address - Phone:614-257-3760
Practice Address - Fax:614-257-3150
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-24
Last Update Date:2013-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0700052101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional