Provider Demographics
NPI:1689150641
Name:HEARTHSTONE FAMILY COUNSELING, LLC
Entity Type:Organization
Organization Name:HEARTHSTONE FAMILY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:BLUMELL
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:801-362-9953
Mailing Address - Street 1:243 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-7225
Mailing Address - Country:US
Mailing Address - Phone:801-362-9953
Mailing Address - Fax:
Practice Address - Street 1:578 E 300 S
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-3831
Practice Address - Country:US
Practice Address - Phone:801-763-5010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9838277-6004251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1952791741Medicaid