Provider Demographics
NPI:1700105749
Name:HEEGAARD, PAULA S (MFT)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:S
Last Name:HEEGAARD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3781 NATHAN WAY
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4518
Mailing Address - Country:US
Mailing Address - Phone:650-855-9690
Mailing Address - Fax:
Practice Address - Street 1:2672 BAYSHORE PKWY
Practice Address - Street 2:SUITE 612
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-1001
Practice Address - Country:US
Practice Address - Phone:650-855-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMF20103106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist