Healthcare Provider Details

I. General information

NPI: 1699922393
Provider Name (Legal Business Name): JACOB KAWA'A HEFFERNAN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7861 JUNIPER FOREST ST
LAS VEGAS NV
89139-6439
US

IV. Provider business mailing address

7861 JUNIPER FOREST ST
LAS VEGAS NV
89139-6439
US

V. Phone/Fax

Practice location:
  • Phone: 808-840-9565
  • Fax:
Mailing address:
  • Phone: 808-840-9565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number5106-R
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number356
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: