Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 36512 | TX |
Y | 103T00000X | Psychologist | 36512 | TX |
NPI | 1003242710 |
---|---|
Provider Name | David Robert Heckler |
First Address | Austin, TX 78701-1137 |
Second Address | Austin, TX 78731-6405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2013 |
Last Update Date | 25/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
335907701 | (05) | TX |