Provider Demographics
NPI:1447357140
Name:HERON RIDGE ASSOCIATES PLC
Entity type:Organization
Organization Name:HERON RIDGE ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, SECRETARY, TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-605-4986
Mailing Address - Street 1:2550 S TELEGRAPH RD STE 250
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0909
Mailing Address - Country:US
Mailing Address - Phone:248-322-0003
Mailing Address - Fax:
Practice Address - Street 1:31000 TELEGRAPH RD STE 120
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4321
Practice Address - Country:US
Practice Address - Phone:248-594-4991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010216511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI463240OtherVALUE OPTIONS
MI10605OtherBLUE CROSS BLUE SHIELD MI
MI463240OtherVALUE OPTIONS