Provider Demographics
NPI:1912421090
Name:HEATH, CODY (LMFT)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:HEATH
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5604 W 134TH TER APT 1511
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-4057
Mailing Address - Country:US
Mailing Address - Phone:806-292-6438
Mailing Address - Fax:
Practice Address - Street 1:110 E POPLAR ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3306
Practice Address - Country:US
Practice Address - Phone:806-292-6438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2879106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty