Healthcare Provider Details

I. General information

NPI: 1891864567
Provider Name (Legal Business Name): CAROLYN HENINGER MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 EAST 4800 SOUTH SUITE 200 SUN DANCE BEHAVIORAL RESOURCES LLC
MURRAY UT
84107
US

IV. Provider business mailing address

845 EAST 4800 SOUTH SUITE 200 SUN DANCE BEHAVIORAL RESOURCES LLC
MURRAY UT
84107
US

V. Phone/Fax

Practice location:
  • Phone: 801-264-9522
  • Fax: 801-265-9604
Mailing address:
  • Phone: 801-264-9522
  • Fax: 801-265-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number136102-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: