Provider Demographics
NPI:1609015197
Name:HEIM, CAROL JEAN (MFT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:HEIM
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 HOAG PL
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-7209
Mailing Address - Country:US
Mailing Address - Phone:530-574-8740
Mailing Address - Fax:530-758-1289
Practice Address - Street 1:105 E ST
Practice Address - Street 2:SUITE 2-H
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4697
Practice Address - Country:US
Practice Address - Phone:530-574-8740
Practice Address - Fax:530-758-1289
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44976106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist