1871769729 NPI number — HEIDI MICHELE LEWIN-MILLER LMFT, RD

Table of content: HEIDI MICHELE LEWIN-MILLER LMFT, RD (NPI 1871769729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871769729 NPI number — HEIDI MICHELE LEWIN-MILLER LMFT, RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIN-MILLER
Provider First Name:
HEIDI
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT, RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871769729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1110 CALIFORNIA BLVD
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93401-2949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-549-9778
Provider Business Mailing Address Fax Number:
805-549-9778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 CALIFORNIA BLVD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
SAN LUIS OBISPO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93401-2949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-549-9778
Provider Business Practice Location Address Fax Number:
805-549-9778
Provider Enumeration Date:
05/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  RD 675059 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: MFC35120 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11964683 . This is a "BLUE CROSS OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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