Provider Demographics
NPI:1598203135
Name:DYCK, HEIDI NOELLE
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:NOELLE
Last Name:DYCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12540 PENSKE ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5207
Mailing Address - Country:US
Mailing Address - Phone:951-490-3909
Mailing Address - Fax:
Practice Address - Street 1:85 RAMONA EXPY
Practice Address - Street 2:STE 1-4
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-7014
Practice Address - Country:US
Practice Address - Phone:951-940-6203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health