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General NPI Number Information
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NPI Number | 1780528711
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Entity Type | Organization
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Legal Business Name | BRIGHT HAVEN PSYCHOLOGY PC
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Dates
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Enumeration Date | 04/18/2026
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Last Update Date | 04/18/2026
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Provider Practice Location Address
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Address Line | 12000 RIVERSIDE DR UNIT 332
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-6020
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Country | US
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Telephone | 747-447-7355
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Fax |
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Provider Business Mailing Address
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Address Line | 4804 LAUREL CANYON BLVD # 1254
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-3717
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Country | US
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Telephone | 747-447-7355
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER, PRESIDENT
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Name | DR. HEATHER CHARISSE HETTINGER
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Credential | PSYD
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Telephone | 747-447-7355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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