Provider Demographics
NPI:1376840090
Name:HEPNER, NATHAN REED (LPC)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:REED
Last Name:HEPNER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W MORRISON ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:FAYETTE
Mailing Address - State:MO
Mailing Address - Zip Code:65248-1075
Mailing Address - Country:US
Mailing Address - Phone:660-248-3088
Mailing Address - Fax:
Practice Address - Street 1:600 W MORRISON ST
Practice Address - Street 2:SUITE 18
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248-1075
Practice Address - Country:US
Practice Address - Phone:660-248-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010039581101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional