Provider Demographics
NPI:1437173879
Name:HEIDER, DONNA LEE (MFT, ATR)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LEE
Last Name:HEIDER
Suffix:
Gender:F
Credentials:MFT, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 15TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2756
Mailing Address - Country:US
Mailing Address - Phone:310-458-3370
Mailing Address - Fax:310-451-9665
Practice Address - Street 1:1448 15TH ST STE 203
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2756
Practice Address - Country:US
Practice Address - Phone:310-458-3370
Practice Address - Fax:310-451-9665
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT24458101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT24458OtherLICENSED MARRIAGEAND FAMI