NPIMap

Organization Active NPI

Heartland Community Church, Inc.

  • Psychologist
  • Winter Haven, FL
National Provider Identifier
1063937845
Registry record updated Mar 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PY8924 Issued in FL
Legal business name
HEARTLAND COMMUNITY CHURCH, INC.
Practice address
203 Ave a NW
Suite 300
Winter Haven, FL 33881-4540
Phone
(863) 299-7787
Fax
(863) 299-7757
NPI assigned
Aug 14, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Robert Kirk Allison Jr., PSY.D.NPI 1518384742
Title
Director
Phone
(863) 299-7787

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X PY8924 FL Primary

Addresses

Primary practice location

203 Ave a NW
Suite 300
Winter Haven, FL 33881-4540

Mailing address

203 Ave a NW
Suite 300
Winter Haven, FL 33881-4540
Phone (863) 299-7787

Other names 1

  • Heartland Counseling Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191211003009 FL Part B Supplier - Clinic/Group Practice 2466885090 Receives reassigned benefits from 5 practitioners
Practice locations: Winter Haven, FL

National Provider Directory

National Provider Directory

Locations

50 4th St S
Lake Wales, FL 33853
Phone (863) 299-7787

300 3rd St NW
Winter Haven, FL 33881

301 3rd St NW
Ste 212
Winter Haven, FL 33881
Phone (863) 299-7787

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742947200000",
    "number": "1063937845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 AVE A NW",
            "address_2": "SUITE 300",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338814540",
            "telephone_number": "863-299-7787",
            "fax_number": "863-299-7757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 AVE A NW",
            "address_2": "SUITE 300",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338814540",
            "telephone_number": "863-299-7787",
            "fax_number": "863-299-7757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND COMMUNITY CHURCH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-14",
        "last_updated": "2025-03-26",
        "status": "A",
        "authorized_official_last_name": "ALLISON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "KIRK",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "863-299-7787",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY8924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartland Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winter Haven, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.