Provider Demographics
NPI:1346733037
Name:BEISTER, HEATHER D (MSCC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
Last Name:BEISTER
Suffix:
Gender:F
Credentials:MSCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WOODCHASE DR APT 63
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1421
Mailing Address - Country:US
Mailing Address - Phone:573-366-0292
Mailing Address - Fax:573-883-7537
Practice Address - Street 1:1012 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-2914
Practice Address - Country:US
Practice Address - Phone:573-218-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MO2019006197101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1346733037Medicaid