Provider Demographics
NPI:1811338700
Name:HEITSHUSEN, SUSAN (LMHC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:HEITSHUSEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 NW 114TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-7011
Mailing Address - Country:US
Mailing Address - Phone:515-657-7072
Mailing Address - Fax:515-657-7073
Practice Address - Street 1:1370 NW 114TH ST STE 201
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7011
Practice Address - Country:US
Practice Address - Phone:515-657-7072
Practice Address - Fax:515-657-7073
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2021-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072855101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health