Provider Demographics
NPI:1982095147
Name:CLEVELAND, HEIDI (LCPC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 S ROCK RD STE 110
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67210-1857
Mailing Address - Country:US
Mailing Address - Phone:316-640-0084
Mailing Address - Fax:316-221-7079
Practice Address - Street 1:2626 S ROCK RD STE 110
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67210-1857
Practice Address - Country:US
Practice Address - Phone:316-640-0084
Practice Address - Fax:316-221-7079
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2465101YM0800X
KS2759101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health