Basic Information
| Provider Information | |||||||||
| NPI: | 1689120255 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEINBERG | ||||||||
| FirstName: | HEATHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 189 | ||||||||
| Address2: | 730 SPRING DRIVE | ||||||||
| City: | TOQUERVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847745086 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 730 SPRING DRIVE | ||||||||
| Address2: | |||||||||
| City: | TOQUERVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847745086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356350300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 10/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 9484108-6010 | UT | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.