Provider Demographics
NPI:1619221850
Name:MEHUDAR, HEATHER (PHD, LMT, REV, RM)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:MEHUDAR
Suffix:
Gender:F
Credentials:PHD, LMT, REV, RM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 S. EASTERN AVE.
Mailing Address - Street 2:SUITE: 509
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-1843
Mailing Address - Country:US
Mailing Address - Phone:702-477-5927
Mailing Address - Fax:
Practice Address - Street 1:2800 S. EASTERN AVE.
Practice Address - Street 2:SUITE: 509
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-1843
Practice Address - Country:US
Practice Address - Phone:702-477-5927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1964225700000X
NVMEHUDAR101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral