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General NPI Number Information
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NPI Number | 1689924243
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Entity Type | Individual
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Provider Name | HEIDI NICOLE SOMPHITHACK LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 4000 BARRANCA PKWY STE 250
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City | IRVINE
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State | CA
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Zip | 92604-1713
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Country | US
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Telephone | 949-433-9136
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Fax |
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Provider Business Mailing Address
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Address Line | 14271 JEFFREY RD # 603
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City | IRVINE
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State | CA
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Zip | 92620-3405
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Country | US
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Telephone | 949-433-9136
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMF78089
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF78089
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License Number State | CA
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