Provider Demographics
NPI:1053898296
Name:REID, HEIDI (AMFT EXTERN)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:AMFT EXTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N 1400 E
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-2153
Mailing Address - Country:US
Mailing Address - Phone:801-851-5406
Mailing Address - Fax:
Practice Address - Street 1:199 N 290 W STE 150
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-5004
Practice Address - Country:US
Practice Address - Phone:855-229-2336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT108463383905106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist