Healthcare Provider Details

I. General information

NPI: 1326558305
Provider Name (Legal Business Name): RICHARD CLARKE HEYES LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7339 EL CAJON BLVD STE J
LA MESA CA
91942-7435
US

IV. Provider business mailing address

7339 EL CAJON BLVD STE J
LA MESA CA
91942-7435
US

V. Phone/Fax

Practice location:
  • Phone: 858-634-8327
  • Fax:
Mailing address:
  • Phone: 858-634-8327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number102213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: