Provider Demographics
NPI:1770081713
Name:HART, HEATHER MICHELLE (MSW, LMHC)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MICHELLE
Last Name:HART
Suffix:
Gender:F
Credentials:MSW, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-1209
Mailing Address - Country:US
Mailing Address - Phone:509-436-1777
Mailing Address - Fax:
Practice Address - Street 1:1516 W RIVERSIDE AVE STE 208
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1241
Practice Address - Country:US
Practice Address - Phone:509-436-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
WASC607373981041C0700X
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical