Provider Demographics
NPI:1841342458
Name:COTTLE, HEIDI (MFT)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:
Last Name:COTTLE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:LYNN
Other - Last Name:WALDRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1512
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92781-1512
Mailing Address - Country:US
Mailing Address - Phone:714-730-3688
Mailing Address - Fax:
Practice Address - Street 1:17350 MT HERRMANN STREET
Practice Address - Street 2:SUITE A
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-444-3463
Practice Address - Fax:714-444-1768
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33462106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist