Healthcare Provider Details

I. General information

NPI: 1750060901
Provider Name (Legal Business Name): HEALTH-E LIVING PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S LEXINGTON ST STE 100
HARRISONVILLE MO
64701-2444
US

IV. Provider business mailing address

2305 S PONCA AVE
INDEPENDENCE MO
64057-2451
US

V. Phone/Fax

Practice location:
  • Phone: 816-379-6932
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS HEINECKE
Title or Position: CO-FOUNDER
Credential: PSY.D.
Phone: 816-379-6932