Provider Demographics
NPI:1154449981
Name:BUSTOS, HEATHER LYNN (MA, MFT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LYNN
Last Name:BUSTOS
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1241
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92593-1241
Mailing Address - Country:US
Mailing Address - Phone:951-764-8251
Mailing Address - Fax:
Practice Address - Street 1:41890 ENTERPRISE CIR S
Practice Address - Street 2:SUITE 280
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4819
Practice Address - Country:US
Practice Address - Phone:951-764-8251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC49127106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist