MEDICARE: JACOB KAWA'A HEFFERNAN LMFT

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	106H00000X	Marriage & Family Therapist	5106-R	NV
2	106H00000X	Marriage & Family Therapist	356	HI

General Provider Information

NPI Number	:	1699922393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB KAWA'A HEFFERNAN LMFT

Provider Business Mailing Address
First Line	:	7861 JUNIPER FOREST ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6439
Country	:	US
Telephone Number	:	808-840-9565
Fax Number	:

Provider Business Practice Location Address
First Line	:	7861 JUNIPER FOREST ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6439
Country	:	US
Telephone Number	:	808-840-9565
Fax Number	:

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

Provider Enumeration Date	:	08/25/2008
Last Update Date	:	08/14/2025

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