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General NPI Number Information
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NPI Number | 1629687405
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Entity Type | Individual
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Provider Name | MAUREEN THERESE HEISTERKAMP LPCC
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Gender | Female
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Dates
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Enumeration Date | 07/28/2020
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 2800 EUCLID AVE STE 100
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City | CLEVELAND
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State | OH
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Zip | 44115-2418
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Country | US
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Telephone | 617-379-0496
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Fax |
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Provider Business Mailing Address
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Address Line | 161 BROOKFIELD RD
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City | AVON LAKE
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State | OH
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Zip | 44012-1574
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | C.2103454
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.2303736
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License Number State | OH
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