Healthcare Provider Details

I. General information

NPI: 1376474114
Provider Name (Legal Business Name): ANGELA MARIE HEARD CDPT.CO.60339829
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 S WENAS RD
SELAH WA
98942-9155
US

IV. Provider business mailing address

2303 S WENAS RD
SELAH WA
98942-9155
US

V. Phone/Fax

Practice location:
  • Phone: 509-902-4744
  • Fax:
Mailing address:
  • Phone: 509-902-4744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDPT.CO.60339829
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: