Provider Demographics
NPI:1801043625
Name:HEISEN, LINDA KAY (MFT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:KAY
Last Name:HEISEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 WILSHIRE BLVD. #2200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010
Mailing Address - Country:US
Mailing Address - Phone:213-382-4400
Mailing Address - Fax:213-382-4494
Practice Address - Street 1:3600 WILSHIRE BLVD. #2200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010
Practice Address - Country:US
Practice Address - Phone:213-382-4400
Practice Address - Fax:213-382-4494
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33023106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist