Provider Demographics
NPI:1427441963
Name:HARTZELL, HEATHER DAWN
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:DAWN
Last Name:HARTZELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-5922
Mailing Address - Country:US
Mailing Address - Phone:479-599-8987
Mailing Address - Fax:
Practice Address - Street 1:1329 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-5922
Practice Address - Country:US
Practice Address - Phone:479-599-8987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
OK6948101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor