Provider Demographics
NPI:1376812305
Name:HEPPE, DALE R (LMHC)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:R
Last Name:HEPPE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2319 S HIGHWAY 77 UNIT 457
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-7720
Mailing Address - Country:US
Mailing Address - Phone:850-481-8189
Mailing Address - Fax:850-248-0277
Practice Address - Street 1:114 AIRPORT RD # A
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4605
Practice Address - Country:US
Practice Address - Phone:850-481-8189
Practice Address - Fax:850-248-0277
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10915103TC0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical