Healthcare Provider Details

I. General information

NPI: 1245978253
Provider Name (Legal Business Name): HEIDI GOERZEN COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 COMMERCE DR
HESSTON KS
67062-8938
US

IV. Provider business mailing address

114 COMMERCE DR
HESSTON KS
67062-8938
US

V. Phone/Fax

Practice location:
  • Phone: 620-869-9986
  • Fax:
Mailing address:
  • Phone: 620-869-9986
  • Fax: 620-869-9046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: HEIDI J GOERZEN
Title or Position: OWNER
Credential: LSCSW
Phone: 574-312-9342