MEDICARE: ZOE RENEE HISEY LMHCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MC61298256	WA

General Provider Information

NPI Number	:	1215669445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZOE RENEE HISEY LMHCA

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-0307
Country	:	US
Telephone Number	:	425-765-9074
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 MAIN AVE S STE 210
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-8197
Country	:	US
Telephone Number	:	425-765-9074
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	06/27/2022

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