Individual
DR. MICHAEL HEFFERNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD CP
Contact information
Practice address
408 N THIRD STREET, FULTON, TX 78358
(361) 463-6115
Mailing address
PO BOX 2321, FULTON, TX 78358-2321
(361) 463-6115
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
22178
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
035457301
—
TX
Enumeration date
10/10/2005
Last updated
08/10/2012
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