Organization
HEATHER DEVEREAUX, LSCSW, RPT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. HEATHER DEVEREAUX LSCSW, RPT (OWNER)
(316) 993-6139
Entity
Organization
Contact information
Practice address
560 N EXPOSITION ST, WICHITA, KS 67203-5902
(316) 993-6139
Mailing address
14118 W HIGHLAND SPRINGS CT, WICHITA, KS 67235-8060
(316) 993-6139
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4737
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952710451
—
KS
Enumeration date
08/10/2018
Last updated
08/10/2018
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