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General NPI Number Information
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NPI Number | 1710767819
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Entity Type | Individual
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Provider Name | AKASHA MCMILLAN HEINZIG
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Gender | Female
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Dates
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Enumeration Date | 10/05/2023
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Last Update Date | 07/11/2024
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Provider Practice Location Address
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Address Line | 2036 NEVADA CITY HWY # 426
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City | GRASS VALLEY
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State | CA
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Zip | 95945-7700
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Country | US
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Telephone | 406-201-9765
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Fax |
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Provider Business Mailing Address
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Address Line | 125 MOES RUN
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City | KALISPELL
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State | MT
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Zip | 59901-2138
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Country | US
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Telephone |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 147983
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License Number State | CA
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