Healthcare Provider Details

I. General information

NPI: 1780528711
Provider Name (Legal Business Name): BRIGHT HAVEN PSYCHOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2026
Last Update Date: 04/18/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 RIVERSIDE DR UNIT 332
VALLEY VILLAGE CA
91607-6020
US

IV. Provider business mailing address

4804 LAUREL CANYON BLVD # 1254
VALLEY VILLAGE CA
91607-3717
US

V. Phone/Fax

Practice location:
  • Phone: 747-447-7355
  • Fax:
Mailing address:
  • Phone: 747-447-7355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. HEATHER CHARISSE HETTINGER
Title or Position: CHIEF EXECUTIVE OFFICER, PRESIDENT
Credential: PSYD
Phone: 747-447-7355