Provider Demographics
NPI:1427423987
Name:HEAGLE, TROY DELBERT (LADC)
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:DELBERT
Last Name:HEAGLE
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-5549
Mailing Address - Country:US
Mailing Address - Phone:218-454-3263
Mailing Address - Fax:218-454-3151
Practice Address - Street 1:2215 S 6TH ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-5549
Practice Address - Country:US
Practice Address - Phone:218-454-3263
Practice Address - Fax:218-454-3151
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303003101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)