Provider Demographics
NPI:1346610326
Name:HEIDTBRINK, DANIEL (MA, PLPC, NCC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:HEIDTBRINK
Suffix:
Gender:M
Credentials:MA, PLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 VILLAGE DR
Mailing Address - Street 2:GARDEN LEVEL 30
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-4979
Mailing Address - Country:US
Mailing Address - Phone:816-545-9203
Mailing Address - Fax:816-279-3311
Practice Address - Street 1:3500 VILLAGE DR
Practice Address - Street 2:GARDEN LEVEL 30
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-4979
Practice Address - Country:US
Practice Address - Phone:816-545-9203
Practice Address - Fax:816-279-3311
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015035193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional