Provider Demographics
NPI:1427015460
Name:CALLISTER, HEATHER SEVERN (MS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:SEVERN
Last Name:CALLISTER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 E SOUTH TEMPLE
Mailing Address - Street 2:SALT LAKE CITY
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1247
Mailing Address - Country:US
Mailing Address - Phone:801-505-1332
Mailing Address - Fax:
Practice Address - Street 1:275 E SOUTH TEMPLE STE 101
Practice Address - Street 2:SALT LAKE CITY
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1243
Practice Address - Country:US
Practice Address - Phone:801-505-1332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6024101-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist