Provider Demographics
NPI:1265453781
Name:MATHAT, HEIDI (LMFT)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:MATHAT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6102 WILLOWMONT CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95842-2711
Mailing Address - Country:US
Mailing Address - Phone:916-606-6124
Mailing Address - Fax:
Practice Address - Street 1:7509 MADISON AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7467
Practice Address - Country:US
Practice Address - Phone:916-956-6625
Practice Address - Fax:916-338-6127
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2010-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40701106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000008462OtherMEDICAL PROVIDER