Provider Demographics
NPI:1740238013
Name:HEYWARD, KENT (ACSW,LMFT,SAP)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:HEYWARD
Suffix:
Gender:M
Credentials:ACSW,LMFT,SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1422
Mailing Address - Street 2:
Mailing Address - City:EAGLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97524
Mailing Address - Country:US
Mailing Address - Phone:541-941-2159
Mailing Address - Fax:
Practice Address - Street 1:136 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524
Practice Address - Country:US
Practice Address - Phone:541-941-2159
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTO334101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional