Provider Demographics
NPI:1720963903
Name:HECKLER, MARYELLEN (PHD)
Entity type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:
Last Name:HECKLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 S UNION AVE # 406
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-2347
Mailing Address - Country:US
Mailing Address - Phone:727-479-3785
Mailing Address - Fax:
Practice Address - Street 1:860 BOARDMAN CANFIELD RD STE 203
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4235
Practice Address - Country:US
Practice Address - Phone:330-779-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health