Provider Demographics
NPI:1417969510
Name:HEUSER, KATHY LORRAINE (PSYD LPCC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LORRAINE
Last Name:HEUSER
Suffix:
Gender:F
Credentials:PSYD LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MCANDREWS RD W. #213
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337
Mailing Address - Country:US
Mailing Address - Phone:612-275-9863
Mailing Address - Fax:612-435-6659
Practice Address - Street 1:1500 MCANDREWS RD W. #213
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337
Practice Address - Country:US
Practice Address - Phone:612-275-9863
Practice Address - Fax:612-435-6659
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN000217101YP2500X
MN00357101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional