Provider Demographics
NPI:1568509354
Name:HEATON, DAVID C (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:HEATON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 W 900 N
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-4120
Mailing Address - Country:US
Mailing Address - Phone:435-865-1670
Mailing Address - Fax:
Practice Address - Street 1:1760 N MAIN ST
Practice Address - Street 2:SUITE 209
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-7775
Practice Address - Country:US
Practice Address - Phone:435-680-1316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT341120-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT341120-3501OtherSTATE LICENSE
UT005529917Medicare ID - Type UnspecifiedCC LOCATION