Provider Demographics
NPI:1861227266
Name:KIRCHENHEITER, THOMAS WILLIAM
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:KIRCHENHEITER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:FORT LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66027-1107
Mailing Address - Country:US
Mailing Address - Phone:435-901-2700
Mailing Address - Fax:
Practice Address - Street 1:820 BEAR TAVERN RD
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-1021
Practice Address - Country:US
Practice Address - Phone:435-565-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07148200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker