Provider Demographics
NPI:1407285455
Name:HEIDERSCHEIT, JOSEPH ROBERT (MED LPCC, LPAT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ROBERT
Last Name:HEIDERSCHEIT
Suffix:
Gender:M
Credentials:MED LPCC, LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 RUFER AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1669
Mailing Address - Country:US
Mailing Address - Phone:502-716-0002
Mailing Address - Fax:
Practice Address - Street 1:1428 RUFER AVE APT 1
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1669
Practice Address - Country:US
Practice Address - Phone:502-716-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-09
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1542101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional