Provider Demographics
NPI:1700763679
Name:ELISABETH HEINER, PSYD., P.C.
Entity type:Organization
Organization Name:ELISABETH HEINER, PSYD., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:360-301-1381
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-0628
Mailing Address - Country:US
Mailing Address - Phone:360-301-1381
Mailing Address - Fax:360-252-9078
Practice Address - Street 1:1111 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6638
Practice Address - Country:US
Practice Address - Phone:360-301-1381
Practice Address - Fax:360-252-9078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1902395619OtherCMS