Provider Demographics
NPI:1639386055
Name:HEYDRICH, LEVENTE VON (PHD, LLMSW, LBSW)
Entity Type:Individual
Prefix:DR
First Name:LEVENTE
Middle Name:VON
Last Name:HEYDRICH
Suffix:
Gender:M
Credentials:PHD, LLMSW, LBSW
Other - Prefix:DR
Other - First Name:LEVENTE
Other - Middle Name:
Other - Last Name:VON HEYDRICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:6144 WORTHMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-9209
Mailing Address - Country:US
Mailing Address - Phone:517-323-2713
Mailing Address - Fax:
Practice Address - Street 1:4515 W SAGINAW HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2740
Practice Address - Country:US
Practice Address - Phone:517-488-7018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020836531041C0700X
MI68010858301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801085830OtherMASTER'S SOCIAL WORKER LI
MI6802083653OtherBSW SOCIAL WORKER LICENSE
MI4101006507OtherMARRIAGE AND FAMILY THERAPIST