Provider Demographics
NPI:1588075980
Name:HEIBEL, ELISSA FAYE (EDS)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:FAYE
Last Name:HEIBEL
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:ELISSA
Other - Middle Name:FAYE
Other - Last Name:FATTIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS
Mailing Address - Street 1:3314 26TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-2361
Mailing Address - Country:US
Mailing Address - Phone:402-564-9888
Mailing Address - Fax:402-564-9899
Practice Address - Street 1:3314 26TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-2361
Practice Address - Country:US
Practice Address - Phone:402-564-9888
Practice Address - Fax:402-564-9899
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10587101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health