Provider Demographics
NPI:1043989163
Name:BLAND, HEATHER (LMFT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BLAND
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 1:1800 STATE ST APT 78
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2170
Mailing Address - Country:US
Mailing Address - Phone:773-505-1033
Mailing Address - Fax:
Practice Address - Street 1:1800 STATE ST APT 78
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2170
Practice Address - Country:US
Practice Address - Phone:773-505-1033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125824106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist