Individual
HEATHER JEBANANTHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 PRISON RD, REPRESA, CA 95671-3000
(916) 985-8610
Mailing address
100 PRISON RD, REPRESA, CA 95671-3000
(916) 985-8610
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY31844
CA
Other
Enumeration date
08/10/2016
Last updated
09/14/2022
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