Provider Demographics
NPI:1932427465
Name:ROTH, HEIDI (LMHC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:ROTH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 WESTLAKE AVE N
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2704
Mailing Address - Country:US
Mailing Address - Phone:206-442-2007
Mailing Address - Fax:
Practice Address - Street 1:1800 WESTLAKE AVE N
Practice Address - Street 2:SUITE 303
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2704
Practice Address - Country:US
Practice Address - Phone:206-442-2007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health