Provider Demographics
NPI:1942778444
Name:VERNON, HEIDI (AMFT)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:
Last Name:VERNON
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2442
Mailing Address - Country:US
Mailing Address - Phone:713-878-9005
Mailing Address - Fax:
Practice Address - Street 1:66 W VINE ST STE 1
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2185
Practice Address - Country:US
Practice Address - Phone:435-241-4920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10870234-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist