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NPI Code Detail

MEDICARE: MRS. HEATHER MCNEIL PRUSSACK

MEDICARE: MRS. HEATHER MCNEIL PRUSSACK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1386709186
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. HEATHER MCNEIL PRUSSACK
Provider Business Mailing Address
First Line : 1664 BROADWAY
Second Line :
City : EL CAJON
State : CA
Zip : 92021-5201
Country : US
Telephone Number : 619-579-8685
Fax Number : 619-579-1969
Provider Business Practice Location Address
First Line : 1664 BROADWAY
Second Line :
City : EL CAJON
State : CA
Zip : 92021-5201
Country : US
Telephone Number : 619-579-8685
Fax Number : 619-579-1969
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. HEATHER MCNEIL PRUSSACK ” Practice Location

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