Healthcare Provider Details

I. General information

NPI: 1558744938
Provider Name (Legal Business Name): ALLISON HEFLEY PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2015
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 W OLYMPIC BLVD STE 1265E
LOS ANGELES CA
90064-5814
US

IV. Provider business mailing address

11835 W OLYMPIC BLVD STE 1265E
LOS ANGELES CA
90064-5814
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-4843
  • Fax: 310-273-5056
Mailing address:
  • Phone: 310-273-4843
  • Fax: 310-273-5056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY30614
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: