Provider Demographics
NPI:1306484787
Name:HEILMAN, JILL RENAE
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:RENAE
Last Name:HEILMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 S JOHN DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495-5177
Mailing Address - Country:US
Mailing Address - Phone:903-815-1671
Mailing Address - Fax:
Practice Address - Street 1:15048 US HIGHWAY 75 STE 4
Practice Address - Street 2:
Practice Address - City:VAN ALSTYNE
Practice Address - State:TX
Practice Address - Zip Code:75495-3226
Practice Address - Country:US
Practice Address - Phone:903-815-1671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79610101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health