Provider Demographics
NPI:1609386572
Name:HIGGINS, MYSTY (LPCC)
Entity Type:Individual
Prefix:
First Name:MYSTY
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11037 BARNWALL ST APT 7
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-6107
Mailing Address - Country:US
Mailing Address - Phone:619-633-6622
Mailing Address - Fax:
Practice Address - Street 1:11037 BARNWALL ST APT 7
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-6107
Practice Address - Country:US
Practice Address - Phone:619-633-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4152101YM0800X
CAAPCC4152101YP2500X
CALPCC9657101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health