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General NPI Number Information
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NPI Number | 1447739354
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Entity Type | Organization
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Legal Business Name | HEATHER DEVEREAUX, LSCSW, RPT
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Dates
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Enumeration Date | 08/10/2018
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Last Update Date | 08/10/2018
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Provider Practice Location Address
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Address Line | 560 N EXPOSITION ST
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City | WICHITA
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State | KS
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Zip | 67203-5902
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Country | US
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Telephone | 316-993-6139
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Fax |
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Provider Business Mailing Address
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Address Line | 14118 W HIGHLAND SPRINGS CT
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City | WICHITA
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State | KS
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Zip | 67235-8060
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Country | US
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Telephone | 316-993-6139
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. HEATHER DEVEREAUX
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Credential | LSCSW, RPT
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Telephone | 316-993-6139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4737
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License Number State | KS
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