Provider Demographics
NPI:1467529040
Name:HEYWOOD, JOSEPH KEITH (MC, MHC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:KEITH
Last Name:HEYWOOD
Suffix:
Gender:M
Credentials:MC, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 N 49TH ST
Mailing Address - Street 2:#3
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-2622
Mailing Address - Country:US
Mailing Address - Phone:402-817-4799
Mailing Address - Fax:
Practice Address - Street 1:2300 S 16TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3704
Practice Address - Country:US
Practice Address - Phone:801-481-5376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8128101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health