| Doctor Name: | JONATHAN MARCUS HEYWARD |
| NPI Number: | 1043627029 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | 67795 |
| Business Practice Address: | 620 East Concho Rockport, TX - 78382 |
| Business Phone Number: | 3617270988 |
| Business Fax Number: | 3617270991 |
| Mailing Address: | P.o Box 1336, PORTLAND |
| State: | TX |
| Postal Code: | 783742213 |
| Phone Number: | 3617773991 |
| Fax Number: | 3617770610 |
| NPI Enumeration Date: | 07/22/2014 |
| NPI Last Update Date: | 07/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 67795 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |