Healthcare Provider Details

I. General information

NPI: 1679979355
Provider Name (Legal Business Name): HEIDI REISHUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2014
Last Update Date: 02/21/2026
Certification Date: 02/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 PILGRIM CREEK RD
NOXON MT
59853-9721
US

IV. Provider business mailing address

3 PILGRIM CREEK RD
NOXON MT
59853-9721
US

V. Phone/Fax

Practice location:
  • Phone: 208-304-0376
  • Fax:
Mailing address:
  • Phone: 208-304-0376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHK.LH.70026072
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberSWP-LCPC-LIC-1430
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: