Healthcare Provider Details

I. General information

NPI: 1376812305
Provider Name (Legal Business Name): DALE R HEPPE LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 09/21/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 AIRPORT RD # A
PANAMA CITY FL
32405-4605
US

IV. Provider business mailing address

2319 S HIGHWAY 77 UNIT 457
LYNN HAVEN FL
32444-7720
US

V. Phone/Fax

Practice location:
  • Phone: 850-481-8189
  • Fax: 850-248-0277
Mailing address:
  • Phone: 850-481-8189
  • Fax: 850-248-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberMH10915
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10915
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: