Provider Demographics
NPI:1609400134
Name:HEITMAN, EMILY (LMFT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:HEITMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5155 E RIVER RD STE 401
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3777
Mailing Address - Country:US
Mailing Address - Phone:763-780-3307
Mailing Address - Fax:763-780-3306
Practice Address - Street 1:5155 E RIVER RD STE 401
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55421-3777
Practice Address - Country:US
Practice Address - Phone:763-780-3307
Practice Address - Fax:763-780-3306
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3635106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist