Healthcare Provider Details

I. General information

NPI: 1205355153
Provider Name (Legal Business Name): MS. HEATHER ELYSE CALHOON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 HUNTINGTON DR STE 328
SOUTH PASADENA CA
91030-5478
US

IV. Provider business mailing address

615 MONTCLAIR DR
CHEYENNE WY
82009-2750
US

V. Phone/Fax

Practice location:
  • Phone: 323-345-1402
  • Fax:
Mailing address:
  • Phone: 661-473-3992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number36670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: