Provider Demographics
NPI:1255667770
Name:THOMAS, HEATHER ELIZABETH (LMFT MFC 52806)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMFT MFC 52806
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 PALMER DRIVE
Mailing Address - Street 2:SUITE 4 257
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682
Mailing Address - Country:US
Mailing Address - Phone:805-234-2834
Mailing Address - Fax:888-519-3159
Practice Address - Street 1:3294 ROYAL DR
Practice Address - Street 2:SUITE 201A
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8534
Practice Address - Country:US
Practice Address - Phone:805-234-2834
Practice Address - Fax:888-519-3159
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF61360106H00000X
CA52806106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist