Provider Demographics
NPI:1720750169
Name:DESERT HEALING, PLLC
Entity Type:Organization
Organization Name:DESERT HEALING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANWAGONER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:801-541-1308
Mailing Address - Street 1:2297 HILLRISE CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8025
Mailing Address - Country:US
Mailing Address - Phone:801-541-1308
Mailing Address - Fax:
Practice Address - Street 1:135 N 900 E
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3024
Practice Address - Country:US
Practice Address - Phone:801-541-1308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty