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General NPI Number Information
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NPI Number | 1841942109
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Entity Type | Individual
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Provider Name | HEATHER A CLINKENBEARD
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Gender | Female
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 2082 MICHELSON DR STE 214
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City | IRVINE
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State | CA
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Zip | 92612-1212
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Country | US
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Telephone | 949-946-8701
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Fax |
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Provider Business Mailing Address
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Address Line | 1 ALICANTE
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3850
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Country | US
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Telephone | 949-280-5774
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY31273
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License Number State | CA
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