Individual ProviderRichard Michael HeavenrichCounselorBehavioral Health & Social Service ProvidersPractice Address628 N Main St, Royal Oak, MI 48067-1834(248) 544-9330PECOS EnrollmentBased on the most recent information from CMS, provider Richard Michael Heavenrich does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1205993490Provider TypeIndividualFull NameHeavenrich, Richard MichaelTitleDr.CredentialPH.D.GenderMaleSole ProprietorYesEnumeration Date1/3/2007Last Updated7/8/2007Contact InformationPractice LocationPractice Address628 N Main St, Royal Oak, MI 48067-1834Phone(248) 544-9330Fax(248) 544-9330Mailing LocationMailing Address628 N Main St, Royal Oak, MI 48067-1834Phone(248) 544-9330Fax(248) 544-9330Provider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicense6301002375MichiganProvider IdentifiersIDDescriptionIssuerID11278327DescriptionOtherIssuerCAQH ID NUMBERMichigan