Provider Demographics
NPI:1992049530
Name:HEIFNER, KEITH (LPC)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:HEIFNER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 DONNER DR
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-7745
Mailing Address - Country:US
Mailing Address - Phone:865-481-3972
Mailing Address - Fax:865-481-0319
Practice Address - Street 1:103 DONNER DR
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7745
Practice Address - Country:US
Practice Address - Phone:865-481-3972
Practice Address - Fax:865-481-0319
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health