Healthcare Provider Details

I. General information

NPI: 1013783158
Provider Name (Legal Business Name): KATHERINE HEUBECK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 01/16/2024
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 81ST AVE
OAKLAND CA
94621-2455
US

IV. Provider business mailing address

2828 FORD ST
OAKLAND CA
94601-2114
US

V. Phone/Fax

Practice location:
  • Phone: 510-879-5570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number143544
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: