Provider Demographics
NPI:1710117882
Name:HEPTINSTALL, TERRY (MA, LMFT, LPCC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:HEPTINSTALL
Suffix:
Gender:M
Credentials:MA, LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23282 MILL CREEK DR STE 220
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1678
Mailing Address - Country:US
Mailing Address - Phone:714-264-5456
Mailing Address - Fax:
Practice Address - Street 1:23282 MILL CREEK DR STE 220
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1678
Practice Address - Country:US
Practice Address - Phone:714-264-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2017-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT47075106H00000X
CALPCC 1622101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional