Provider Demographics
NPI:1427691021
Name:LAIRD, HEATHER (PSYD MFT, LMFT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:LAIRD
Suffix:
Gender:F
Credentials:PSYD MFT, LMFT
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:LAIRD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD MFT, LMFT
Mailing Address - Street 1:PO BOX 1584
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-0584
Mailing Address - Country:US
Mailing Address - Phone:202-270-0341
Mailing Address - Fax:
Practice Address - Street 1:9649 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3308
Practice Address - Country:US
Practice Address - Phone:202-270-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-26
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108776106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty