MEDICARE: HEIDI REISHUS

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	101YP2500X	Professional Counselor	SWP-LCPC-LIC-1430	MT

General Provider Information

NPI Number	:	1679979355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI REISHUS

Provider Business Mailing Address
First Line	:	16 FLOCKERZI RD
Second Line	:
City	:	TROUT CREEK
State	:	MT
Zip	:	59874-9547
Country	:	US
Telephone Number	:	406-215-1309
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 FLOCKERZI RD
Second Line	:
City	:	TROUT CREEK
State	:	MT
Zip	:	59874-9547
Country	:	US
Telephone Number	:	406-215-1309
Fax Number	:

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

Provider Enumeration Date	:	11/07/2014
Last Update Date	:	10/07/2016

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Directions to “ HEIDI REISHUS ” Practice Location

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