Individual provider Active NPI

Heather Marshall, PHD

  • Clinical Psychologist
  • Tallahassee, FL
National Provider Identifier
1568080299
Registry record updated Dec 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071.011009 Issued in IL
Practice address
2450 Tim Gamble PL Ste 240
Tallahassee, FL 32308-4384
Phone
(708) 789-9539
NPI assigned
Jul 9, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 9, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Psychologist 103TC0700X 071.011009 IL Primary
Clinical Psychologist 103TC0700X PY12754 FL

Addresses

Primary practice location

2450 Tim Gamble PL Ste 240
Tallahassee, FL 32308-4384

Mailing address

2450 Tim Gamble PL Ste 240
Tallahassee, FL 32308-4384
Phone (708) 789-9539

Other practice location 1

770 Lake Cook Rd Ste 200
Deerfield, IL 60015-4920
Phone (847) 219-4249

Other practice location 2

4 Allegheny Ctr Fl 8
Pittsburgh, PA 15212-5255
Phone (412) 330-4391

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

LicenseStateTypeSpecialty
PY12754FLMDClinical Psychologist
071.011009ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Wise Mind Psychology Services PLLC Clinical CurrentSince Dec 14, 2025 Accepting new patients

Locations

2450 Tim Gamble Pl
Ste 240
Tallahassee, FL 32308
Phone (708) 789-9539

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1594252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765238400000",
    "number": "1568080299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 TIM GAMBLE PL STE 240",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084384",
            "telephone_number": "708-789-9539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 TIM GAMBLE PL STE 240",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084384",
            "telephone_number": "708-789-9539"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "770 Lake Cook Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Deerfield",
            "state": "IL",
            "postal_code": "600154920",
            "country_code": "US",
            "telephone_number": "847-219-4249",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4 Allegheny Ctr Fl 8",
            "address_purpose": "LOCATION",
            "city": "Pittsburgh",
            "state": "PA",
            "postal_code": "152125255",
            "country_code": "US",
            "telephone_number": "412-330-4391",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "HEATHER",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-09",
        "last_updated": "2025-12-09",
        "certification_date": "2025-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.011009",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY12754",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.