MEDICARE: MS. HEATHER MICHELLE HART MSW, LMHC

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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	SC60737398	WA
3	101YM0800X	Mental Health Counselor		WA

General Provider Information

NPI Number	:	1770081713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER MICHELLE HART MSW, LMHC

Provider Business Mailing Address
First Line	:	3408 W 3RD AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-1209
Country	:	US
Telephone Number	:	509-436-1777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 W RIVERSIDE AVE STE 208
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-1241
Country	:	US
Telephone Number	:	509-436-1777
Fax Number	:

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

Provider Enumeration Date	:	01/24/2018
Last Update Date	:	09/12/2022

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