Healthcare Provider Details

I. General information

NPI: 1417969510
Provider Name (Legal Business Name): KATHY LORRAINE HEUSER PSYD LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MCANDREWS RD W. #213
BURNSVILLE MN
55337
US

IV. Provider business mailing address

1500 MCANDREWS RD W. #213
BURNSVILLE MN
55337
US

V. Phone/Fax

Practice location:
  • Phone: 612-275-9863
  • Fax: 612-435-6659
Mailing address:
  • Phone: 612-275-9863
  • Fax: 612-435-6659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number000217
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number00357
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: