Basic Information
| Provider Information | |||||||||
| NPI: | 1710362892 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | AVINA-HEINL | ||||||||
| FirstName: | TORI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29748 RANCHO CALIFORNIA RD | ||||||||
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| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925915286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516940695 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1900 BRICE RD STE B | ||||||||
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| City: | REYNOLDSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430683403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142399965 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2015 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 96272 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | F.2000138 | OH | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.