Provider Demographics
NPI:1063794279
Name:DAVENPORT, HEATHER (MA, LMFT#101616)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:MA, LMFT#101616
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:GUIDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:513 VALLEY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-3562
Mailing Address - Country:US
Mailing Address - Phone:925-957-5306
Mailing Address - Fax:
Practice Address - Street 1:202 GLACIER DR FL 2
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553
Practice Address - Country:US
Practice Address - Phone:925-957-5306
Practice Address - Fax:925-957-2746
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73583106H00000X
390200000X
CALMFT101616106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program