MEDICARE: MS. HEATHER ANNE ROYAL BA

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	B001280919	CA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1497002190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER ANNE ROYAL BA

Provider Business Mailing Address
First Line	:	PO BOX 1559
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93302-1559
Country	:	US
Telephone Number	:	661-397-8775
Fax Number	:	661-617-2098

Provider Business Practice Location Address
First Line	:	3117 WILSON RD
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93304-5319
Country	:	US
Telephone Number	:	661-324-4756
Fax Number	:	661-617-2099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	07/26/2022

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