Provider Demographics
NPI:1639361942
Name:HELLER, CAROL LYNN (LMFT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNN
Last Name:HELLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2494 LAKE TAHOE BLVD
Mailing Address - Street 2:SUITE C3
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-7719
Mailing Address - Country:US
Mailing Address - Phone:530-541-4594
Mailing Address - Fax:530-542-1200
Practice Address - Street 1:2494 LAKE TAHOE BLVD
Practice Address - Street 2:SUITE C3
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7719
Practice Address - Country:US
Practice Address - Phone:530-541-4594
Practice Address - Fax:530-542-1200
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT18362106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist