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General NPI Number Information
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NPI Number | 1720750169
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Entity Type | Organization
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Legal Business Name | DESERT HEALING, PLLC
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 135 N 900 E
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City | SAINT GEORGE
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State | UT
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Zip | 84770-3024
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Country | US
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Telephone | 801-541-1308
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Fax |
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Provider Business Mailing Address
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Address Line | 2297 HILLRISE CIR
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City | SAINT GEORGE
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State | UT
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Zip | 84790-8025
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Country | US
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Telephone | 801-541-1308
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIANE VANWAGONER
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Credential | LPC
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Telephone | 801-541-1308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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