Healthcare Provider Details

I. General information

NPI: 1306551098
Provider Name (Legal Business Name): KIRSTEN HEYER M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 MISSOURI AVENUE
SULLIVAN MO
63080
US

IV. Provider business mailing address

212 BOARDWALK COURT
UNION MO
63084
US

V. Phone/Fax

Practice location:
  • Phone: 636-388-1669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2022049318
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: