Provider Demographics
NPI:1821656547
Name:WHYTE, HEATHER JEAN (LMFT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JEAN
Last Name:WHYTE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:WHYTE
Other - Last Name:MAWLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:469 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3249
Mailing Address - Country:US
Mailing Address - Phone:415-509-2431
Mailing Address - Fax:
Practice Address - Street 1:469 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-3249
Practice Address - Country:US
Practice Address - Phone:415-509-2431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42305106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1568965143Medicaid