Provider Demographics
NPI:1437337557
Name:HOLMGREN, HEATHER HOLMGREN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:HOLMGREN
Last Name:HOLMGREN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:HOLMGREN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:835 EAST 300 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2908
Mailing Address - Country:US
Mailing Address - Phone:435-730-2973
Mailing Address - Fax:
Practice Address - Street 1:124 SOUTH 400 EAST
Practice Address - Street 2:SUITE 240
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-4625
Practice Address - Country:US
Practice Address - Phone:435-730-2973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6784106-3904106H00000X
UT6784106-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055266OtherRAILROAD MEDICARE
UT876000308007Medicaid