Provider Demographics
NPI:1851425235
Name:AMBROSE, HEATHER JEAN (PHD, LMFT, LPC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:JEAN
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:PHD, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 N 250 W
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5840
Mailing Address - Country:US
Mailing Address - Phone:270-361-1000
Mailing Address - Fax:
Practice Address - Street 1:1109 N 250 W
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5840
Practice Address - Country:US
Practice Address - Phone:270-361-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7981025-3902106H00000X
UT7981205-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health