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General NPI Number Information
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NPI Number | 1689150641
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Entity Type | Organization
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Legal Business Name | HEARTHSTONE FAMILY COUNSELING, LLC
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 07/12/2018
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Provider Practice Location Address
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Address Line | 578 E 300 S
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City | AMERICAN FORK
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State | UT
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Zip | 84003-3831
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Country | US
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Telephone | 801-763-5010
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Fax |
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Provider Business Mailing Address
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Address Line | 243 RIDGE RD
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City | OREM
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State | UT
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Zip | 84057-7225
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Country | US
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Telephone | 801-362-9953
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Fax |
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | MRS. MELISSA JOY BLUMELL
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Credential | CMHC
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Telephone | 801-362-9953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 9838277-6004
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License Number State | UT
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