Healthcare Provider Details

I. General information

NPI: 1578607404
Provider Name (Legal Business Name): HEATHER ALLENE BEDELL L.C.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. HEATHER ALLENE BRADLEY

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 MISSION RD BUILDING A, SUITE 111
PRAIRIE VILLAGE KS
66208
US

IV. Provider business mailing address

5214 ALBERVAN
SHAWNEE KS
66216
US

V. Phone/Fax

Practice location:
  • Phone: 913-213-3760
  • Fax: 913-381-4201
Mailing address:
  • Phone: 913-213-3760
  • Fax: 913-381-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2004037143
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC 2335
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: