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General NPI Number Information
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NPI Number | 1356944474
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Entity Type | Individual
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Provider Name | HEIDI PACE
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Gender | Female
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Dates
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Enumeration Date | 11/19/2020
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 11273 S GRANDVILLE AVE APT K323
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City | SOUTH JORDAN
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State | UT
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Zip | 84009-1934
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Country | US
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Telephone | 801-599-9132
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Fax |
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Provider Business Mailing Address
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Address Line | 11273 S GRANDVILLE AVE APT K323
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City | SOUTH JORDAN
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State | UT
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Zip | 84009-1934
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Country | US
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Telephone | 801-599-9132
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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 | Y6536080
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License Number State | CA
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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 | 95440686009
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License Number State | UT
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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 | 96149
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License Number State | TX
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