Provider Demographics
NPI:1659843704
Name:TEMPLE, HEATHER KRISTINE (CDP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:KRISTINE
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2509
Mailing Address - Country:US
Mailing Address - Phone:360-274-3262
Mailing Address - Fax:360-274-3345
Practice Address - Street 1:2232 S SILVER LAKE RD
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:WA
Practice Address - Zip Code:98611-8021
Practice Address - Country:US
Practice Address - Phone:360-274-3262
Practice Address - Fax:360-274-3345
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60771834101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2118103Medicaid