Provider Demographics
NPI:1871769729
Name:LEWIN-MILLER, HEIDI MICHELE (LMFT, RD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:MICHELE
Last Name:LEWIN-MILLER
Suffix:
Gender:F
Credentials:LMFT, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 CALIFORNIA BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2949
Mailing Address - Country:US
Mailing Address - Phone:805-549-9778
Mailing Address - Fax:805-549-9778
Practice Address - Street 1:1110 CALIFORNIA BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2949
Practice Address - Country:US
Practice Address - Phone:805-549-9778
Practice Address - Fax:805-549-9778
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARD 675059133V00000X
CAMFC35120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11964683OtherBLUE CROSS OF CALIFORNIA