Healthcare Provider Details

I. General information

NPI: 1346610326
Provider Name (Legal Business Name): DANIEL HEIDTBRINK MA, PLPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 VILLAGE DR GARDEN LEVEL 30
SAINT JOSEPH MO
64506-4979
US

IV. Provider business mailing address

3500 VILLAGE DR GARDEN LEVEL 30
SAINT JOSEPH MO
64506-4979
US

V. Phone/Fax

Practice location:
  • Phone: 816-545-9203
  • Fax: 816-279-3311
Mailing address:
  • Phone: 816-545-9203
  • Fax: 816-279-3311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2015035193
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: