Basic Information
| Provider Information | |||||||||
| NPI: | 1609121631 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GROSS | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2077 | ||||||||
| Address2: | |||||||||
| City: | UKIAH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954822077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074672010 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 110 E MENDOCINO AVE | ||||||||
| Address2: | |||||||||
| City: | WILLITS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954903508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074672010 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2012 | ||||||||
| LastUpdateDate: | 07/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 107940 | CA | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | 1096 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | 107940 | CA | N | Other Service Providers | Case Manager/Care Coordinator | 106H00000X | 107940 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.