Provider Demographics
NPI:1578607404
Name:BEDELL, HEATHER ALLENE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ALLENE
Last Name:BEDELL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:ALLENE
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5214 ALBERVAN
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216
Mailing Address - Country:US
Mailing Address - Phone:913-213-3760
Mailing Address - Fax:913-381-4201
Practice Address - Street 1:7301 MISSION RD
Practice Address - Street 2:BUILDING A, SUITE 111
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208
Practice Address - Country:US
Practice Address - Phone:913-213-3760
Practice Address - Fax:913-381-4201
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004037143101YP2500X
KSLCPC 2335101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional