Provider Demographics
NPI:1174268155
Name:HEAL WA PLLC
Entity Type:Organization
Organization Name:HEAL WA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-261-2411
Mailing Address - Street 1:PO BOX 1173
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877-1173
Mailing Address - Country:US
Mailing Address - Phone:208-261-2411
Mailing Address - Fax:866-291-4766
Practice Address - Street 1:2105 112TH AVE NE STE 201
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2945
Practice Address - Country:US
Practice Address - Phone:208-261-2411
Practice Address - Fax:866-291-4766
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-03
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty