Provider Demographics
NPI:1093409146
Name:ALDEA HEALING CENTER PLLC
Entity Type:Organization
Organization Name:ALDEA HEALING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-556-4826
Mailing Address - Street 1:12562 S KIMBER LN
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-4310
Mailing Address - Country:US
Mailing Address - Phone:801-556-4826
Mailing Address - Fax:
Practice Address - Street 1:12562 S KIMBER LN
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-4310
Practice Address - Country:US
Practice Address - Phone:801-556-4826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty