MEDICARE: KENT HEYWARD ACSW,LMFT,SAP

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
1	101YP2500X	Professional Counselor	TO334	OR

General Provider Information

NPI Number	:	1740238013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENT HEYWARD ACSW,LMFT,SAP

Provider Business Mailing Address
First Line	:	PO BOX 1422
Second Line	:
City	:	EAGLE POINT
State	:	OR
Zip	:	97524
Country	:	US
Telephone Number	:	541-941-2159
Fax Number	:

Provider Business Practice Location Address
First Line	:	136 WEST MAIN STREET
Second Line	:
City	:	EAGLE POINT
State	:	OR
Zip	:	97524
Country	:	US
Telephone Number	:	541-941-2159
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/08/2007

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