Provider Demographics
NPI:1699825547
Name:HASSENTEUFEL, HEIDE M
Entity Type:Individual
Prefix:MRS
First Name:HEIDE
Middle Name:M
Last Name:HASSENTEUFEL
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 1:212 S JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-2419
Mailing Address - Country:US
Mailing Address - Phone:559-934-1120
Mailing Address - Fax:
Practice Address - Street 1:311 N 5TH ST
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-1703
Practice Address - Country:US
Practice Address - Phone:559-593-5634
Practice Address - Fax:559-934-0697
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37482106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist