Provider Demographics
NPI:1972578615
Name:HEYEN, GINA D (LCMFT)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:D
Last Name:HEYEN
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:D
Other - Last Name:LEIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1223 N ROCK RD
Mailing Address - Street 2:BUILDING G SUITE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1269
Mailing Address - Country:US
Mailing Address - Phone:316-636-2888
Mailing Address - Fax:316-636-2366
Practice Address - Street 1:1223 N ROCK RD
Practice Address - Street 2:BUILDING G SUITE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1269
Practice Address - Country:US
Practice Address - Phone:316-636-2888
Practice Address - Fax:316-636-2366
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS184106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist