Healthcare Provider Details

I. General information

NPI: 1073901401
Provider Name (Legal Business Name): HEATHER ALLISON MALIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 08/04/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 NORTH HIDDEN VALLEY ROAD
LEEDS UT
84746
US

IV. Provider business mailing address

PO BOX 461224
LEEDS UT
84746-1224
US

V. Phone/Fax

Practice location:
  • Phone: 702-275-5305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number139725756004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC19395
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCP0213
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: