Provider Demographics
NPI:1699374439
Name:LEX, HEIDEMARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:HEIDEMARIE
Middle Name:
Last Name:LEX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 E KENNEDY DR APT 605
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2156
Mailing Address - Country:US
Mailing Address - Phone:857-284-3080
Mailing Address - Fax:
Practice Address - Street 1:3125 E KENNEDY DR APT 605
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-2156
Practice Address - Country:US
Practice Address - Phone:857-284-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty