Provider Demographics
NPI:1427487495
Name:PATIN, HEATHER MICHELLE (MA, BCBA)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MICHELLE
Last Name:PATIN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16946 SHERMAN WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3613
Mailing Address - Country:US
Mailing Address - Phone:818-235-1414
Mailing Address - Fax:818-235-1418
Practice Address - Street 1:16946 SHERMAN WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3613
Practice Address - Country:US
Practice Address - Phone:818-235-1414
Practice Address - Fax:818-235-1418
Is Sole Proprietor?:No
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-13566103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst