Provider Demographics
NPI:1255667960
Name:GUAY, HEATHER A (MFTI)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:A
Last Name:GUAY
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:GUAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFTI
Mailing Address - Street 1:8469 PLANETARY DR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3368
Mailing Address - Country:US
Mailing Address - Phone:714-309-7819
Mailing Address - Fax:
Practice Address - Street 1:8469 PLANETARY DR
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-3368
Practice Address - Country:US
Practice Address - Phone:714-309-7819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60530225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner