Provider Demographics
NPI:1437220662
Name:FITZCHARLES, HEATHER ANN (EDSLPC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:FITZCHARLES
Suffix:
Gender:F
Credentials:EDSLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7329 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1357
Mailing Address - Country:US
Mailing Address - Phone:816-561-9494
Mailing Address - Fax:816-561-8199
Practice Address - Street 1:7329 BROADWAY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1357
Practice Address - Country:US
Practice Address - Phone:816-561-9494
Practice Address - Fax:816-561-8199
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2415101YP2500X
MO2003002169101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional