Provider Demographics
NPI:1336498757
Name:ALLSBROOK, HEATHER JOELLE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JOELLE
Last Name:ALLSBROOK
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 1:14137 CALIFA ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-3605
Mailing Address - Country:US
Mailing Address - Phone:562-822-6714
Mailing Address - Fax:
Practice Address - Street 1:4510 E. PCH SUITE 210
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3279
Practice Address - Country:US
Practice Address - Phone:562-822-6714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47706101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health