Individual
MS. LISETTE T HEIDTKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2120 NE 12TH AVE, PORTLAND, OR 97212-4306
(269) 598-5152
(208) 834-3164
Mailing address
3055 NW YEON AVE, PMB 400, PORTLAND, OR 97210-1519
(269) 598-5152
(208) 834-3164
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
C6716
OR
101YM0800X
Mental Health Counselor
C6716
OR
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
C6716
OR
Other
Enumeration date
10/18/2017
Last updated
10/26/2022
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