Healthcare Provider Details

I. General information

NPI: 1053932657
Provider Name (Legal Business Name): NICHOLAS PATRICK HEPLER QMHP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 EXECUTIVE DR STE 200
FAIRVIEW HEIGHTS IL
62208-1350
US

IV. Provider business mailing address

5125 ROSA AVE
SAINT LOUIS MO
63109-3245
US

V. Phone/Fax

Practice location:
  • Phone: 618-688-4727
  • Fax:
Mailing address:
  • Phone: 636-866-6113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: