Provider Demographics
NPI:1255843181
Name:CLOVER SPRINGS COUNSELING PLLC
Entity Type:Organization
Organization Name:CLOVER SPRINGS COUNSELING PLLC
Other - Org Name:HEIDI H. CHENEY LCSW
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHENEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-836-5555
Mailing Address - Street 1:1431 N 1200 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2449
Mailing Address - Country:US
Mailing Address - Phone:801-836-5555
Mailing Address - Fax:
Practice Address - Street 1:1431 N 1200 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2449
Practice Address - Country:US
Practice Address - Phone:801-836-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7383330-3501261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT7383330-3501OtherDOPL