Healthcare Provider Details

I. General information

NPI: 1063579159
Provider Name (Legal Business Name): TINA M HEUSLER MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 LIBERTY RD
STEELVILLE MO
65565-4537
US

IV. Provider business mailing address

425 LIBERTY RD
STEELVILLE MO
65565-4537
US

V. Phone/Fax

Practice location:
  • Phone: 573-259-6742
  • Fax:
Mailing address:
  • Phone: 573-259-6742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004657
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: