Provider Demographics
NPI:1548535222
Name:RIST, HEATHER LEEANN (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:LEEANN
Last Name:RIST
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W FRONT ST STE A
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-2609
Mailing Address - Country:US
Mailing Address - Phone:360-452-7891
Mailing Address - Fax:360-452-8087
Practice Address - Street 1:240 W FRONT ST STE A
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-2609
Practice Address - Country:US
Practice Address - Phone:360-452-7891
Practice Address - Fax:360-452-8087
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMX70034133101YM0800X
AZ14159101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional