Provider Demographics
NPI:1386711984
Name:HECK, ROBERT PAUL (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:HECK
Suffix:
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 1:10315 DAWSONS CREEK BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1912
Mailing Address - Country:US
Mailing Address - Phone:260-387-6340
Mailing Address - Fax:
Practice Address - Street 1:10315 DAWSONS CREEK BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1912
Practice Address - Country:US
Practice Address - Phone:260-387-6340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2004-1203A103T00000X
OH5386103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000-777-2138OtherAETNA NON-PAR
IN000-000-175-606OtherBC-BS NON-PAR
IN200984000OtherMAGELLAN BEHAVIORAL
OHCO-4030771Medicare ID - Type UnspecifiedMEDICARE PROVIDER - OH
IN200984000OtherMAGELLAN BEHAVIORAL