Provider Demographics
NPI:1649425927
Name:HEYMAN-BOLE, ORLY (MAET,CHT,LMFT)
Entity type:Individual
Prefix:
First Name:ORLY
Middle Name:
Last Name:HEYMAN-BOLE
Suffix:
Gender:F
Credentials:MAET,CHT,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3735
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95063-3735
Mailing Address - Country:US
Mailing Address - Phone:831-429-2212
Mailing Address - Fax:
Practice Address - Street 1:147 S RIVER ST
Practice Address - Street 2:SUITE 213
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4551
Practice Address - Country:US
Practice Address - Phone:831-429-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-30
Last Update Date:2008-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42096106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist