Healthcare Provider Details

I. General information

NPI: 1093350910
Provider Name (Legal Business Name): HEAVEN BEAM-LONGWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21825 ERWIN ST STE 1062
WOODLAND HILLS CA
91367-3610
US

IV. Provider business mailing address

21825 ERWIN ST STE 1062
WOODLAND HILLS CA
91367-3610
US

V. Phone/Fax

Practice location:
  • Phone: 424-955-1595
  • Fax:
Mailing address:
  • Phone: 424-527-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number144223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: