Healthcare Provider Details

I. General information

NPI: 1891811709
Provider Name (Legal Business Name): SOPHIA HEFNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1453 N MAIN ST. SUITE F
SAN LUIS AZ
85349
US

IV. Provider business mailing address

PO BOX 8103
SAN LUIS AZ
85349-6822
US

V. Phone/Fax

Practice location:
  • Phone: 928-627-6567
  • Fax: 928-722-7025
Mailing address:
  • Phone: 928-627-6567
  • Fax: 928-722-7025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: