Provider Demographics
NPI:1790079762
Name:RUSSO, HEATHER (LMFT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:RUSSO
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 1:2601 S. FIGUEROA
Mailing Address - Street 2:BLDG 1 FLOOR 2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007
Mailing Address - Country:US
Mailing Address - Phone:805-651-9621
Mailing Address - Fax:
Practice Address - Street 1:2601 S. FIGUEROA
Practice Address - Street 2:BLDG 1 FLOOR 2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007
Practice Address - Country:US
Practice Address - Phone:805-651-9621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49556106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist