Provider Demographics
NPI:1235443433
Name:HEFFERNAN, AIMEE WHITE (LMFTA)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:WHITE
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16700 NE 79TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4465
Mailing Address - Country:US
Mailing Address - Phone:206-289-0624
Mailing Address - Fax:
Practice Address - Street 1:16700 NE 79TH ST STE 103
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4465
Practice Address - Country:US
Practice Address - Phone:206-289-0624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60106454106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist