Provider Demographics
NPI:1629595558
Name:BIERLEIN, HEIDI NICOLE
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:NICOLE
Last Name:BIERLEIN
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 1:13475 4TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-5390
Mailing Address - Country:US
Mailing Address - Phone:909-380-4915
Mailing Address - Fax:
Practice Address - Street 1:131 CAJON ST STE 4
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4766
Practice Address - Country:US
Practice Address - Phone:909-380-4915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CA9066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst