Provider Demographics
NPI:1215209622
Name:MUMMAW, HEATHER (LMFT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MUMMAW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 FOLSOM RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2767
Mailing Address - Country:US
Mailing Address - Phone:916-790-6024
Mailing Address - Fax:
Practice Address - Street 1:420 FOLSOM RD
Practice Address - Street 2:SUITE C
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2767
Practice Address - Country:US
Practice Address - Phone:916-790-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2016-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT92531106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist