Gary D Heath, LCSW, LMFT
Individual provider Active NPI Marriage & Family Therapist · Elm Grove, WI
NPI 1104981653 · NPPES record last updated Sep 11, 2025
Key facts
- NPI
- 1104981653
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 339-124 (WI)
- Practice address
- 12970 W Bluemound Rd
Suite 105
Elm Grove, WI 53122-2607 - Phone
- (262) 787-2904
- Fax
- (262) 787-2909
- NPI assigned
- Dec 26, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2027-123 | WI | MD | Clinical Social Worker |
| 339-124 | WI | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2027-123 | WI | |
| Marriage & Family Therapist | 106H00000X | 339-124 | WI | Yes |
Addresses
Primary practice location
12970 W Bluemound Rd
Suite 105
Elm Grove, WI 53122-2607
Mailing address
62 E Rossman St
Hartford, WI 53027-1237
Phone (262) 673-3522
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40955300 | Medicaid | WI |
Other providers in Elm Grove, WI
- Kevin A Harry
- Christine Haselhorst
- Carol Therese Haughey
- James R. Hayes
- Martha Haynes
- Michael Hecker
- Stephanie Hein
- Anna Maria Heindl
- Timothy J Hell
- Courtney Herrick
All providers in Elm Grove, WI · Marriage & Family Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.