Healthcare Provider Details

I. General information

NPI: 1114804002
Provider Name (Legal Business Name): LAUREN HEUSSER MA PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 B ST
MARYSVILLE CA
95901-3731
US

IV. Provider business mailing address

PO BOX 1052
PALERMO CA
95968-1052
US

V. Phone/Fax

Practice location:
  • Phone: 530-741-6464
  • Fax:
Mailing address:
  • Phone: 530-592-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: