Provider Demographics
NPI:1932641198
Name:SUTHERLAND, HEATHER (MFT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SUTHERLAND
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 1:1104 WHIPPOORWILL CT
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-1815
Mailing Address - Country:US
Mailing Address - Phone:510-502-1914
Mailing Address - Fax:
Practice Address - Street 1:1104 WHIPPOORWILL CT
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1815
Practice Address - Country:US
Practice Address - Phone:510-502-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44968106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist