Provider Demographics
NPI:1326379413
Name:STEPHENSON, HEATHER (MS, CMHC, LCPC, RPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:MS, CMHC, LCPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 W 100 S STE 122
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4551
Mailing Address - Country:US
Mailing Address - Phone:435-232-6259
Mailing Address - Fax:435-755-0579
Practice Address - Street 1:95 W 100 S
Practice Address - Street 2:SUITE 101
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5810
Practice Address - Country:US
Practice Address - Phone:435-232-6259
Practice Address - Fax:435-755-0579
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-5372101YP2500X
UT7520408-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional