Provider Demographics
NPI:1871489542
Name:HECKLE, KARISA LYNN (MA)
Entity type:Individual
Prefix:
First Name:KARISA
Middle Name:LYNN
Last Name:HECKLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KARISA
Other - Middle Name:LYNN
Other - Last Name:HECKLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KARISA HECKLE, MA
Mailing Address - Street 1:2900 BRISTOL ST STE B320
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5987
Mailing Address - Country:US
Mailing Address - Phone:949-991-1612
Mailing Address - Fax:
Practice Address - Street 1:2900 BRISTOL ST STE B320
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5987
Practice Address - Country:US
Practice Address - Phone:949-991-1612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138785106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist