Provider Demographics
NPI:1497002190
Name:ROYAL, HEATHER ANNE (BA)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ANNE
Last Name:ROYAL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:ANNE
Other - Last Name:MAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1559
Mailing Address - Country:US
Mailing Address - Phone:661-397-8775
Mailing Address - Fax:661-617-2098
Practice Address - Street 1:3117 WILSON RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-5319
Practice Address - Country:US
Practice Address - Phone:661-324-4756
Practice Address - Fax:661-617-2099
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB001280919101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)