Healthcare Provider Details

I. General information

NPI: 1912146176
Provider Name (Legal Business Name): HEATHER FRASER HURTT M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 E BIDWELL ST STE 100
FOLSOM CA
95630-3561
US

IV. Provider business mailing address

2320 E BIDWELL ST STE 100
FOLSOM CA
95630-3561
US

V. Phone/Fax

Practice location:
  • Phone: 916-542-9806
  • Fax:
Mailing address:
  • Phone: 916-542-9806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC40638
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: