Healthcare Provider Details

I. General information

NPI: 1730326919
Provider Name (Legal Business Name): HERITAGE COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1747 HERITAGE LN STE B103
SYRACUSE UT
84075-8546
US

IV. Provider business mailing address

1747 HERITAGE LN STE B103
SYRACUSE UT
84075-8546
US

V. Phone/Fax

Practice location:
  • Phone: 801-525-6975
  • Fax: 801-525-6988
Mailing address:
  • Phone: 801-525-6975
  • Fax: 801-525-6988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number6810992-0162
License Number StateUT

VIII. Authorized Official

Name: DIANA LYNN NEWBERRY
Title or Position: OWNER
Credential: LCSW
Phone: 801-525-6975