Provider Demographics
NPI:1972907806
Name:HEITKE, RICHARD JOSEPH (MS LPCC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOSEPH
Last Name:HEITKE
Suffix:
Gender:M
Credentials:MS LPCC
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 726
Mailing Address - Street 2:
Mailing Address - City:BUHL
Mailing Address - State:MN
Mailing Address - Zip Code:55713-0726
Mailing Address - Country:US
Mailing Address - Phone:218-258-2349
Mailing Address - Fax:218-258-3807
Practice Address - Street 1:200 WANLESS STREET
Practice Address - Street 2:
Practice Address - City:BUHL
Practice Address - State:MN
Practice Address - Zip Code:55713
Practice Address - Country:US
Practice Address - Phone:218-258-2349
Practice Address - Fax:218-258-3807
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00231101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor