Provider Demographics
NPI:1477532257
Name:HEYNEN-CRONIN, HEATHER J (MS, LPC-MH, QMHP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:J
Last Name:HEYNEN-CRONIN
Suffix:
Gender:F
Credentials:MS, LPC-MH, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22941 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8508
Mailing Address - Country:US
Mailing Address - Phone:605-737-4672
Mailing Address - Fax:605-737-4672
Practice Address - Street 1:3202 W MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-1707
Practice Address - Country:US
Practice Address - Phone:605-390-3462
Practice Address - Fax:605-388-8003
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6576080Medicaid