Provider Demographics
NPI:1912445693
Name:CALDWELL, HEATHER (T-LMLP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:T-LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 SE QUAKERVALE RD
Mailing Address - Street 2:P.O. BOX 550
Mailing Address - City:RIVERTON
Mailing Address - State:KS
Mailing Address - Zip Code:66770-4185
Mailing Address - Country:US
Mailing Address - Phone:620-848-2300
Mailing Address - Fax:620-848-2301
Practice Address - Street 1:201 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:KS
Practice Address - Zip Code:66725-1121
Practice Address - Country:US
Practice Address - Phone:620-429-1860
Practice Address - Fax:620-429-1041
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2752103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist