Provider Demographics
NPI:1316456551
Name:HERITAGE, ALLAN JAMES II (PHD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:JAMES
Last Name:HERITAGE
Suffix:II
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 EASTPARK DR STE 208
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7535
Mailing Address - Country:US
Mailing Address - Phone:615-370-4977
Mailing Address - Fax:
Practice Address - Street 1:104 EASTPARK DR STE 208
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7535
Practice Address - Country:US
Practice Address - Phone:615-370-4977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3499103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical