Provider Demographics
NPI:1629471370
Name:HADLOCK-EVANS, HEIDI (LMFT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:HADLOCK-EVANS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:HADLOCK-EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT, MRC
Mailing Address - Street 1:7721 W 900 S
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-9270
Mailing Address - Country:US
Mailing Address - Phone:801-529-6131
Mailing Address - Fax:
Practice Address - Street 1:27 S MAIN ST # 201
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-3704
Practice Address - Country:US
Practice Address - Phone:801-529-6131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8300486-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist