Active NPI
Richard Michael Heavenrich, PH.D.
- Mental Health Counselor
- Royal Oak, MI
National Provider Identifier
1205993490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 6301002375
- Practice address
- 628 N Main St
Royal Oak, MI 48067-1834 - Phone
- (248) 544-9330
- Fax
- (248) 544-9330
- NPI assigned
- Jan 3, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 6301002375 | MI | Primary |
Addresses
Primary practice location
628 N Main St
Royal Oak, MI 48067-1834
Mailing address
628 N Main St
Royal Oak, MI 48067-1834
Phone (248) 544-9330
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11278327 | Other | MI | CAQH ID NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301002375 | MI | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205993490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "628 N MAIN ST",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "480671834",
"telephone_number": "248-544-9330",
"fax_number": "248-544-9330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "628 N MAIN ST",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "480671834",
"telephone_number": "248-544-9330",
"fax_number": "248-544-9330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEAVENRICH",
"first_name": "RICHARD",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MI",
"license": "6301002375",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH ID NUMBER",
"identifier": "11278327",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Royal Oak, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.