Provider Demographics
NPI:1891982492
Name:HELDT, ELIZABETH K (PSS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:HELDT
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:K
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:P.O. BOX 1013
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459
Mailing Address - Country:US
Mailing Address - Phone:541-756-2057
Mailing Address - Fax:517-789-1286
Practice Address - Street 1:377 LACLAIR STREET
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420
Practice Address - Country:US
Practice Address - Phone:541-756-2057
Practice Address - Fax:541-808-2231
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010972711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149-003854OtherSTATE LICENSE
MI6801097271OtherSTATE LICENSE