Provider Demographics
NPI:1336501477
Name:HELLER, JON
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:HELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 S MOUNTVALE CT
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-2108
Mailing Address - Country:US
Mailing Address - Phone:310-422-7335
Mailing Address - Fax:
Practice Address - Street 1:1005 S MOUNTVALE CT
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-2108
Practice Address - Country:US
Practice Address - Phone:310-422-7335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)