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General NPI Number Information
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NPI Number | 1215209622
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Entity Type | Individual
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Provider Name | HEATHER MUMMAW LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/31/2012
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 775 SUNRISE AVE STE 110
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City | ROSEVILLE
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State | CA
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Zip | 95661-4527
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Country | US
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Telephone | 916-790-6024
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Fax | 916-581-4623
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Provider Business Mailing Address
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Address Line | 8863 GREENBACK LN # 191
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City | ORANGEVALE
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State | CA
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Zip | 95662-4059
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Country | US
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Telephone | 916-790-6024
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Fax | 916-581-4623
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT92531
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License Number State | CA
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