Provider Demographics
NPI:1558830687
Name:O'HEARN, MAYRA (CADC III, AMFT)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:O'HEARN
Suffix:
Gender:F
Credentials:CADC III, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18612 SANTA ANA AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:92316-2639
Mailing Address - Country:US
Mailing Address - Phone:094-217-1209
Mailing Address - Fax:909-421-7128
Practice Address - Street 1:18612 SANTA ANA AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:CA
Practice Address - Zip Code:92316-2639
Practice Address - Country:US
Practice Address - Phone:094-217-1209
Practice Address - Fax:909-421-7128
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA138129106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)