Provider Demographics
NPI:1407286602
Name:KINSELLA, HEIDI MARIE (LMHCA)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:MARIE
Last Name:KINSELLA
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 130TH AVE NE STE 104
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1770
Mailing Address - Country:US
Mailing Address - Phone:425-628-2820
Mailing Address - Fax:
Practice Address - Street 1:1800 WESTLAKE AVE N STE 105
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2782
Practice Address - Country:US
Practice Address - Phone:425-652-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60721364101YA0400X
AKPC131270101YM0800X
HIMHC577101YM0800X
WALH60535761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)