Provider Demographics
NPI:1780135897
Name:MAGLOTHIN, HEATHER NICHOL
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICHOL
Last Name:MAGLOTHIN
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 1:233 BASELINE RD
Mailing Address - Street 2:BOX 400
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-2353
Mailing Address - Country:US
Mailing Address - Phone:909-833-2986
Mailing Address - Fax:909-833-2998
Practice Address - Street 1:233 BASELINE RD
Practice Address - Street 2:BOX 400
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-2353
Practice Address - Country:US
Practice Address - Phone:909-833-2986
Practice Address - Fax:909-833-2998
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor