Provider Demographics
NPI:1265705123
Name:HETTINGER, HEATHER (PSYD BCBA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HETTINGER
Suffix:
Gender:F
Credentials:PSYD BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12626 RIVERSIDE DR STE 409
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3451
Mailing Address - Country:US
Mailing Address - Phone:818-661-6306
Mailing Address - Fax:
Practice Address - Street 1:12626 RIVERSIDE DR STE 409
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3451
Practice Address - Country:US
Practice Address - Phone:818-661-6306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-11-4333103K00000X
CAPSY35580103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist