Healthcare Provider Details

I. General information

NPI: 1548535222
Provider Name (Legal Business Name): HEATHER LEEANN RIST MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21727 76TH AVE W STE C
EDMONDS WA
98026-7549
US

IV. Provider business mailing address

PO BOX 8550
PASADENA CA
91109-8602
US

V. Phone/Fax

Practice location:
  • Phone: 253-475-6021
  • Fax: 206-260-2903
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHPL.MX.70034133
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC.LH.70034134
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-14159
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: