Provider Demographics
NPI:1164093514
Name:HEUPEL, MARY KATLYN (BSW)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:KATLYN
Last Name:HEUPEL
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:KATLYN
Other - Last Name:HEUPEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSW
Mailing Address - Street 1:746 COX RD
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-5740
Mailing Address - Country:US
Mailing Address - Phone:256-275-6601
Mailing Address - Fax:
Practice Address - Street 1:1090 OLD FLORENCE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-8401
Practice Address - Country:US
Practice Address - Phone:931-762-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-26
Deactivation Date:2021-07-07
Deactivation Code:
Reactivation Date:2021-07-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator