Provider Demographics
NPI:1649467507
Name:COPELAND, HEATHER REANNA (MFT-I)
Entity type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:REANNA
Last Name:COPELAND
Suffix:
Gender:F
Credentials:MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1887 BUSINESS CENTER DR
Mailing Address - Street 2:#5
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3463
Mailing Address - Country:US
Mailing Address - Phone:909-890-9837
Mailing Address - Fax:
Practice Address - Street 1:1887 BUSINESS CENTER DR
Practice Address - Street 2:#5
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3463
Practice Address - Country:US
Practice Address - Phone:909-890-9837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist