Provider Demographics
NPI:1669589461
Name:HEARIDGE, JENNIFER FLORENCE (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:FLORENCE
Last Name:HEARIDGE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:FLORENCE
Other - Last Name:TIETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:PO BOX 30706
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98228-2706
Mailing Address - Country:US
Mailing Address - Phone:360-305-3660
Mailing Address - Fax:360-320-8540
Practice Address - Street 1:3150 ORLEANS ST BLDG B
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9997
Practice Address - Country:US
Practice Address - Phone:360-305-3660
Practice Address - Fax:360-320-8540
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60159915101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health