Healthcare Provider Details

I. General information

NPI: 1528234150
Provider Name (Legal Business Name): PEARL DELIGHT HEPPNER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2008
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 W SHAW LN SUITE 104
FRESNO CA
93711-2775
US

IV. Provider business mailing address

PO BOX 4304
FRESNO CA
93744-4304
US

V. Phone/Fax

Practice location:
  • Phone: 559-437-3710
  • Fax: 559-437-3720
Mailing address:
  • Phone: 559-437-3710
  • Fax: 559-437-3720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC40217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: