Provider Demographics
NPI:1174659874
Name:ECKHART, HEATHER DIANE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:DIANE
Last Name:ECKHART
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6722 RACCOON RD
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MO
Mailing Address - Zip Code:64844-7111
Mailing Address - Country:US
Mailing Address - Phone:417-499-2899
Mailing Address - Fax:
Practice Address - Street 1:6722 RACCOON RD
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:MO
Practice Address - Zip Code:64844-7111
Practice Address - Country:US
Practice Address - Phone:417-499-2899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
MO20060187981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493736300Medicaid