Healthcare Provider Details

I. General information

NPI: 1548515158
Provider Name (Legal Business Name): HEATHER ANN MOYER B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 ALPINE BLVD
ALPINE CA
91901-2113
US

IV. Provider business mailing address

2120 ALPINE BLVD
ALPINE CA
91901-2113
US

V. Phone/Fax

Practice location:
  • Phone: 619-722-1426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: