Provider Demographics
NPI:1053897306
Name:COLLINS, HEATHER (SCHOOL PSY (WAIVER))
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:SCHOOL PSY (WAIVER)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17506 GOPHER CT
Mailing Address - Street 2:
Mailing Address - City:WEED
Mailing Address - State:CA
Mailing Address - Zip Code:96094-9445
Mailing Address - Country:US
Mailing Address - Phone:530-598-4265
Mailing Address - Fax:
Practice Address - Street 1:609 S GOLD ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3110
Practice Address - Country:US
Practice Address - Phone:530-842-8466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool