Provider Demographics
NPI:1538870753
Name:HEINZE, TRU LOTUS FAYE
Entity type:Individual
Prefix:MRS
First Name:TRU LOTUS
Middle Name:FAYE
Last Name:HEINZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRUDY
Other - Middle Name:MARY
Other - Last Name:GOETCHIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:955 POWELL AVE SW
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 S 2ND ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2011
Practice Address - Country:US
Practice Address - Phone:425-226-5536
Practice Address - Fax:425-226-0354
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMC61676865101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21400OtherLOCAL MEDICARE
MA1319833Medicaid