Healthcare Provider Details

I. General information

NPI: 1124858030
Provider Name (Legal Business Name): ADAM LANE HELDIBRIDLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 W CENTER ST
OREM UT
84057-5202
US

IV. Provider business mailing address

171 S 300 W
SANTAQUIN UT
84655-8192
US

V. Phone/Fax

Practice location:
  • Phone: 435-633-0412
  • Fax:
Mailing address:
  • Phone: 435-633-0412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12985283-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: