Provider Demographics
NPI:1679726673
Name:HECK, GENOVEVA (MED)
Entity type:Individual
Prefix:MRS
First Name:GENOVEVA
Middle Name:
Last Name:HECK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17934 SAUVIGNON CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7595
Mailing Address - Country:US
Mailing Address - Phone:907-622-0412
Mailing Address - Fax:
Practice Address - Street 1:220 SOUTH 3RD PLACE
Practice Address - Street 2:
Practice Address - City:RENTING
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:425-228-0074
Practice Address - Fax:425-226-2531
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101Y00000X, 101YM0800X, 101YP2500X, 101YS0200X, 103K00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist