Provider Demographics
NPI:1407607278
Name:SALAZAR, HEATHER (LPCC, #3824)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:LPCC, #3824
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1779 JASMINE WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-3763
Mailing Address - Country:US
Mailing Address - Phone:760-219-7847
Mailing Address - Fax:
Practice Address - Street 1:1779 JASMINE WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-3763
Practice Address - Country:US
Practice Address - Phone:760-219-7847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3824101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty