Provider Demographics
NPI:1902395619
Name:HEINER, ELISABETH (PSYD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:
Last Name:HEINER
Suffix:
Gender:F
Credentials:PSYD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-0628
Mailing Address - Country:US
Mailing Address - Phone:360-301-1381
Mailing Address - Fax:360-252-9078
Practice Address - Street 1:1111 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6638
Practice Address - Country:US
Practice Address - Phone:360-301-1381
Practice Address - Fax:360-252-9078
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60812633101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health