Provider Demographics
NPI:1194463414
Name:STEPHANIE HEITMAN
Entity Type:Organization
Organization Name:STEPHANIE HEITMAN
Other - Org Name:COUNSELING FOR PSYCHOLOGICAL RESILIENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:515-992-6638
Mailing Address - Street 1:PO BOX 253
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:IA
Mailing Address - Zip Code:50220-0253
Mailing Address - Country:US
Mailing Address - Phone:515-992-6638
Mailing Address - Fax:
Practice Address - Street 1:602 OTLEY AVE
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:IA
Practice Address - Zip Code:50220-1088
Practice Address - Country:US
Practice Address - Phone:515-992-6638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA006958Medicaid
IA107903Medicaid
IA2218121Medicaid