Provider Demographics
NPI:1063579159
Name:HEUSLER, TINA M (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:HEUSLER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:STEELVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65565-4537
Mailing Address - Country:US
Mailing Address - Phone:573-259-6742
Mailing Address - Fax:
Practice Address - Street 1:425 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:STEELVILLE
Practice Address - State:MO
Practice Address - Zip Code:65565-4537
Practice Address - Country:US
Practice Address - Phone:573-259-6742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0046571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical