Provider Demographics
NPI:1275861411
Name:STREET, HEATHER (MS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:STREET
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N PERRIS BLVD
Mailing Address - Street 2:BLDG. A
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-2811
Mailing Address - Country:US
Mailing Address - Phone:951-436-5300
Mailing Address - Fax:951-436-5350
Practice Address - Street 1:555 N PERRIS BLVD
Practice Address - Street 2:BLDG. A
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-2811
Practice Address - Country:US
Practice Address - Phone:951-436-5300
Practice Address - Fax:951-436-5350
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health