Provider Demographics
NPI:1558156117
Name:GREEN, HEATHER RENEE (LPCC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:GREEN
Suffix:
Gender:
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14017 WHITEROCK DR
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-3825
Mailing Address - Country:US
Mailing Address - Phone:602-292-6579
Mailing Address - Fax:
Practice Address - Street 1:14017 WHITEROCK DR
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-3825
Practice Address - Country:US
Practice Address - Phone:602-292-6579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC18991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health