Individual
MR. JAMES A HEACOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LMFT
Contact information
Practice address
3564 MCKINLEY ST NE, MINNEAPOLIS, MN 55418-1511
(612) 978-1748
Mailing address
3564 MCKINLEY ST NE, MINNEAPOLIS, MN 55418-1511
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1350
MN
Other
Enumeration date
11/28/2006
Last updated
07/08/2007
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