Healthcare Provider Details

I. General information

NPI: 1871903773
Provider Name (Legal Business Name): MARY HELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 01/08/2024
Certification Date: 01/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106600 FOUNDERS WAY UNIT 304
BONITA SPRINGS FL
34135
US

IV. Provider business mailing address

1011 MIDWAY DR
ALPINE CA
91901-2752
US

V. Phone/Fax

Practice location:
  • Phone: 239-241-0023
  • Fax:
Mailing address:
  • Phone: 858-869-4227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number23113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: