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NPI Code Detail

MEDICARE: HEIDI COULTER LCSW

MEDICARE: HEIDI COULTER LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker2019047822MO

General Provider Information

NPI Number : 1154961589
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEIDI COULTER LCSW
Provider Business Mailing Address
First Line : 3743 MAIN ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64111-1912
Country : US
Telephone Number : 816-809-5345
Fax Number :
Provider Business Practice Location Address
First Line : 3743 MAIN ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64111-1912
Country : US
Telephone Number : 816-809-5345
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2020
Last Update Date : 01/14/2020

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Directions to “ HEIDI COULTER LCSW” Practice Location

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