Individual provider · Type 1 NPI
Lisette T. Heidtke, LPC
Professional Counselor · Portland, OR
NPI number
1386155356
Active
Practice location
2120 NE 12th Ave
Portland, OR 97212-4306
Fax (208) 834-3164
Mailing address
3055 NW Yeon Ave, Pmb 400
Portland, OR 97210-1519
Other practice locations
- 20025 Mossy Meadows Ave, Oregon City, OR 97045-7136 · (503) 496-0207
- 11458 SE Mceachron Ave, Milwaukie, OR 97222-1264 · (503) 305-6296
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Counselor | 101Y00000X | C6716 (OR) |
| Mental Health Counselor | 101YM0800X | None listed |
| Mental Health Counselor | 101YM0800X | C6716 (OR) |
| Professional Counselor Primary | 101YP2500X | C6716 (OR) |
Professional Counselor: Definition to come...
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About NPI 1386155356
Lisette T. Heidtke, LPC's National Provider Identifier is 1386155356, issued on Oct 18, 2017. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Portland, OR. The record was last updated on Oct 26, 2022.