Provider Demographics
NPI:1134343593
Name:HEIT, STEPHEN P (MA LMCP LCP)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:P
Last Name:HEIT
Suffix:
Gender:M
Credentials:MA LMCP LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3123
Mailing Address - Country:US
Mailing Address - Phone:620-792-2544
Mailing Address - Fax:620-792-4323
Practice Address - Street 1:5815 BROADWAY
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3123
Practice Address - Country:US
Practice Address - Phone:620-792-2544
Practice Address - Fax:620-792-2544
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0042103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098090AMedicaid