MEDICARE: MS. LORETTA C HEISLER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401012942	MI

General Provider Information

NPI Number	:	1548547631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORETTA C HEISLER LPC

Provider Business Mailing Address
First Line	:	491 COLUMBIA AVE E STE 4
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-5468
Country	:	US
Telephone Number	:	269-962-9611
Fax Number	:	269-962-9612

Provider Business Practice Location Address
First Line	:	491 COLUMBIA AVE E STE 4
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-5468
Country	:	US
Telephone Number	:	269-962-9611
Fax Number	:	269-962-9612

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2011
Last Update Date	:	07/17/2020

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