Individual
MR. DAVID J HEITMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
612 E ELM ST, REPUBLIC, MO 65738-1552
(417) 761-5511
(417) 761-5512
Mailing address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
(417) 761-5011
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11-R-22
OR
101YP2500X
Professional Counselor
Primary
2023000446
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11-R-22
CADC II
OR
Enumeration date
09/20/2012
Last updated
07/27/2023
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