Healthcare Provider Details

I. General information

NPI: 1437582368
Provider Name (Legal Business Name): MICHAEL JOSEPH HEGGARTY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CROWN POINT CIR STE 120
GRASS VALLEY CA
95945-9561
US

IV. Provider business mailing address

500 CROWN POINT CIR STE 120
GRASS VALLEY CA
95945-9561
US

V. Phone/Fax

Practice location:
  • Phone: 530-265-1437
  • Fax: 530-271-0257
Mailing address:
  • Phone: 530-265-1437
  • Fax: 530-271-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 20105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: