Provider Demographics
NPI:1821665845
Name:HEFNER, BRUYERE FRANCES
Entity Type:Individual
Prefix:
First Name:BRUYERE
Middle Name:FRANCES
Last Name:HEFNER
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 1:2508 LAKE PARK LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3422
Mailing Address - Country:US
Mailing Address - Phone:949-514-7444
Mailing Address - Fax:
Practice Address - Street 1:4695 MACARTHUR CT STE 1100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1866
Practice Address - Country:US
Practice Address - Phone:949-514-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst