Provider Demographics
NPI:1457482564
Name:HEPPELL, PATRICK J
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:HEPPELL
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 1:720 W 4TH ST UNIT 406
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-2100
Mailing Address - Country:US
Mailing Address - Phone:562-865-3644
Mailing Address - Fax:
Practice Address - Street 1:21520 PIONEER BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-2603
Practice Address - Country:US
Practice Address - Phone:562-865-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health