Provider Demographics
NPI:1952423675
Name:HELLER, MAURI-LYNNE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MAURI-LYNNE
Middle Name:
Last Name:HELLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 TANGELO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4482
Mailing Address - Country:US
Mailing Address - Phone:949-857-5249
Mailing Address - Fax:714-957-1234
Practice Address - Street 1:3151 AIRWAY AVE
Practice Address - Street 2:K-240
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4607
Practice Address - Country:US
Practice Address - Phone:714-662-7975
Practice Address - Fax:714-957-1234
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40296106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist