Lisette T Heidtke, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C6716 Issued in OR

Practice address

2120 NE 12TH Ave
Portland, OR 97212-4306

Phone

(269) 598-5152

Fax

(208) 834-3164

NPI assigned

Oct 18, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Columbiacare Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Portland, OR
  • NPI 1982140588
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1508284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666742400000",
    "number": "1386155356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3055 NW YEON AVE",
            "address_2": "PMB 400",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972101519",
            "telephone_number": "269-598-5152",
            "fax_number": "208-834-3164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 NE 12TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972124306",
            "telephone_number": "269-598-5152",
            "fax_number": "208-834-3164"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20025 Mossy Meadows Ave",
            "address_purpose": "LOCATION",
            "city": "Oregon City",
            "state": "OR",
            "postal_code": "970457136",
            "country_code": "US",
            "telephone_number": "503-496-0207",
            "fax_number": "503-496-0349",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11458 SE McEachron Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukie",
            "state": "OR",
            "postal_code": "972221264",
            "country_code": "US",
            "telephone_number": "503-305-6296",
            "fax_number": "503-387-5279",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HEIDTKE",
        "first_name": "LISETTE",
        "middle_name": "T",
        "name_prefix": "Ms.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-18",
        "last_updated": "2022-10-26",
        "certification_date": "2022-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "OR",
            "license": "C6716",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C6716",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C6716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chen-Wen Chris Heh, M.D.
• Honor Hehn
• Christina Ann Marie Heiberg, RD, CDE
• Rachel Heichen, LMT
• Erin Allyson Heidt-Forsythe
• Elisabeth Heien, CSWA
• Benjamin James Heifetz
• Sonja Mae Heifetz, LPCI
• Jorgi K Heikkila, RN
• James A Heilman, M.D.

• Professional Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.