Provider Demographics
NPI:1093490062
Name:HEIDE, BRETT AUSTIN (MTS)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:AUSTIN
Last Name:HEIDE
Suffix:
Gender:M
Credentials:MTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 675
Mailing Address - Street 2:
Mailing Address - City:LA CYGNE
Mailing Address - State:KS
Mailing Address - Zip Code:66040-0675
Mailing Address - Country:US
Mailing Address - Phone:913-271-6008
Mailing Address - Fax:
Practice Address - Street 1:812 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LA CYGNE
Practice Address - State:KS
Practice Address - Zip Code:66040-3029
Practice Address - Country:US
Practice Address - Phone:913-271-6008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral