Provider Demographics
NPI:1407566466
Name:ROCHA, HEATHER (CRC, PCA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:ROCHA
Suffix:
Gender:F
Credentials:CRC, PCA
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 2131
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97075-2131
Mailing Address - Country:US
Mailing Address - Phone:503-447-3566
Mailing Address - Fax:
Practice Address - Street 1:14800 SW CARLSBAD DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-5924
Practice Address - Country:US
Practice Address - Phone:503-447-3566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7673101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health