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General NPI Number Information
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NPI Number | 1982123006
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Entity Type | Individual
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Provider Name | KENNETH SHINE HEUVELMAN LPC, CAADC, CCS
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Gender | Male
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Dates
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Enumeration Date | 09/11/2017
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 520 SUPERIOR ST
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City | PORT HURON
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State | MI
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Zip | 48060-3838
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Country | US
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Telephone | 810-984-4202
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Fax |
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Provider Business Mailing Address
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Address Line | 3479 MINNIE DR
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City | LAKEPORT
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State | MI
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Zip | 48059-1948
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Country | US
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Telephone | 810-637-1123
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | C-03596
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | BBH-LAC-LIC-24075
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6451022467
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401225382
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License Number State | MI
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