MEDICARE: BRIGHT HAVEN PSYCHOLOGY PC

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1780528711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT HAVEN PSYCHOLOGY PC

Provider Business Mailing Address
First Line	:	4804 LAUREL CANYON BLVD # 1254
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-3717
Country	:	US
Telephone Number	:	747-447-7355
Fax Number	:

Provider Business Practice Location Address
First Line	:	12000 RIVERSIDE DR UNIT 332
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-6020
Country	:	US
Telephone Number	:	747-447-7355
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER, PRESIDENT
Name	:	DR. HEATHER CHARISSE HETTINGER
Credential	:	PSYD
Telephone Number	:	747-447-7355

Provider Enumeration Date	:	04/18/2026
Last Update Date	:	04/18/2026

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