Provider Demographics
NPI:1811073042
Name:HEATH, ROBERT CHARLES (MFT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHARLES
Last Name:HEATH
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 GREGORY LN
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523
Mailing Address - Country:US
Mailing Address - Phone:925-798-3161
Mailing Address - Fax:510-845-1703
Practice Address - Street 1:401 GREGORY LN
Practice Address - Street 2:SUITE 108
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523
Practice Address - Country:US
Practice Address - Phone:925-798-3161
Practice Address - Fax:510-845-1703
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC13974106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist