Healthcare Provider Details

I. General information

NPI: 1356521702
Provider Name (Legal Business Name): LESA H CARTER CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 S 500 E
HEBER CITY UT
84032-1918
US

IV. Provider business mailing address

55 S 500 E
HEBER CITY UT
84032-1918
US

V. Phone/Fax

Practice location:
  • Phone: 435-657-3297
  • Fax: 435-654-1646
Mailing address:
  • Phone: 435-654-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number676409-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6796409-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: