Healthcare Provider Details

I. General information

NPI: 1235063090
Provider Name (Legal Business Name): HEAL YOUR HEART LICENSED MARRIAGE & FAMILY THERAPIST, A CALIFORNIA PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3753 CHURN CREEK RD
REDDING CA
96002-2923
US

IV. Provider business mailing address

3753 CHURN CREEK RD
REDDING CA
96002-2923
US

V. Phone/Fax

Practice location:
  • Phone: 530-255-4041
  • Fax:
Mailing address:
  • Phone: 530-255-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ASHLEY GREEN
Title or Position: CEO
Credential:
Phone: 530-255-4041