Provider Demographics
NPI:1538464938
Name:HEIDEN-KIMBALL, LISA ELAINE (LMHC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ELAINE
Last Name:HEIDEN-KIMBALL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 KIMBALL AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5757
Mailing Address - Country:US
Mailing Address - Phone:319-214-0011
Mailing Address - Fax:888-817-5518
Practice Address - Street 1:3641 KIMBALL AVE STE 102
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5757
Practice Address - Country:US
Practice Address - Phone:319-214-0011
Practice Address - Fax:888-817-5518
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001375101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0074435Medicaid