Provider Demographics
NPI:1659142800
Name:LIBMAN, HEATHER (BA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:LIBMAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:BUCKINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8836 SE 74TH PL
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-5700
Mailing Address - Country:US
Mailing Address - Phone:206-919-2263
Mailing Address - Fax:
Practice Address - Street 1:2366 EASTLAKE AVE E STE 335
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3399
Practice Address - Country:US
Practice Address - Phone:206-639-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health