Healthcare Provider Details

I. General information

NPI: 1235448606
Provider Name (Legal Business Name): MRS. HEATHER LEIGH BULLIS-CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 S AUBURN ST STE C
GRASS VALLEY CA
95945-4318
US

IV. Provider business mailing address

995 HELLING WAY
NEVADA CITY CA
95959-8619
US

V. Phone/Fax

Practice location:
  • Phone: 530-265-5811
  • Fax:
Mailing address:
  • Phone: 530-265-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: