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General NPI Number Information
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NPI Number | 1073901401
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Entity Type | Individual
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Provider Name | HEATHER ALLISON MALIN
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Gender | Female
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Dates
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Enumeration Date | 01/08/2015
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 42 NORTH HIDDEN VALLEY ROAD
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City | LEEDS
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State | UT
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Zip | 84746
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Country | US
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Telephone | 702-275-5305
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 461224
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City | LEEDS
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State | UT
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Zip | 84746-1224
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 139725756004
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC19395
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CP0213
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License Number State | NV
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