Provider Demographics
NPI:1225343056
Name:HIEB, BRADLEY RAY
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:RAY
Last Name:HIEB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 HARMONY CT
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3446
Mailing Address - Country:US
Mailing Address - Phone:801-428-3483
Mailing Address - Fax:801-355-4607
Practice Address - Street 1:42 S 500 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1002
Practice Address - Country:US
Practice Address - Phone:801-428-3483
Practice Address - Fax:801-355-4607
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)