Healthcare Provider Details

I. General information

NPI: 1669297529
Provider Name (Legal Business Name): HEATHER WILLIAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2024
Last Update Date: 11/16/2024
Certification Date: 11/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19361 WILLOWBROOK AVE
YORBA LINDA CA
92886-4330
US

IV. Provider business mailing address

19361 WILLOWBROOK AVE
YORBA LINDA CA
92886-4330
US

V. Phone/Fax

Practice location:
  • Phone: 949-246-6869
  • Fax: 714-386-5129
Mailing address:
  • Phone: 949-246-6869
  • Fax: 714-386-5129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER WILLIAMS
Title or Position: 1ST RESPONDER PSYCHOLOGIST/CEO
Credential: PSYD.
Phone: 714-485-3236