Provider Demographics
NPI:1841939246
Name:HEIMOS, JAMIE (LPC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:HEIMOS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2634 HIGHWAY 109 STE E
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1160
Mailing Address - Country:US
Mailing Address - Phone:636-253-3897
Mailing Address - Fax:
Practice Address - Street 1:2634 HIGHWAY 109 STE E
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1160
Practice Address - Country:US
Practice Address - Phone:636-253-3897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021002597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2021002597OtherSTATE OF MISSOURI