=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396099081
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEIDI DRYER MA, MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2012
-----------------------------------------------------
Last Update Date | 10/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17451 BASTANCHURY RD # 204-33
-----------------------------------------------------
City | YORBA LINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92886-1857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-729-3297
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6201 NEWHAVEN CT # 130
-----------------------------------------------------
City | YORBA LINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92887-4718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-652-3042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LMFT86593
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------