Provider Demographics
NPI:1548317985
Name:HEEREN, ROY CHARLES (LMSW, ACSW)
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:CHARLES
Last Name:HEEREN
Suffix:
Gender:M
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12935 S WEST BAY SHORE DR STE 330
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-6291
Mailing Address - Country:US
Mailing Address - Phone:231-933-4661
Mailing Address - Fax:231-933-4661
Practice Address - Street 1:12935 S WEST BAY SHORE DR STE 330
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-6291
Practice Address - Country:US
Practice Address - Phone:231-933-4661
Practice Address - Fax:231-933-4661
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010206761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI800B800100OtherBLUE CROSS
MI66220002Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER