Provider Demographics
NPI:1174991616
Name:HERITAGE PROFESSIONAL ASSOCIATES
Entity type:Organization
Organization Name:HERITAGE PROFESSIONAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHEMPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-787-8425
Mailing Address - Street 1:1 GALE AVE
Mailing Address - Street 2:2E
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-2065
Mailing Address - Country:US
Mailing Address - Phone:708-296-9023
Mailing Address - Fax:
Practice Address - Street 1:1 GALE AVE
Practice Address - Street 2:2E
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-2065
Practice Address - Country:US
Practice Address - Phone:708-296-9023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.010925101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3633804243OtherBLUE CROSS/BLUE SHIELD