Provider Demographics
NPI:1902309958
Name:GULICK, HEATHER MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:GULICK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7708 PASEO DEL REY APT 8
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8348
Mailing Address - Country:US
Mailing Address - Phone:310-528-3535
Mailing Address - Fax:310-821-7540
Practice Address - Street 1:400 CORPORATE POINTE STE A4000
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-7615
Practice Address - Country:US
Practice Address - Phone:310-574-2813
Practice Address - Fax:310-821-7540
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT98924106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist