Provider Demographics
NPI:1144524612
Name:LEWIS, HEATHER (LSAC)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 S UNIVERSITY AVE
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-4427
Mailing Address - Country:US
Mailing Address - Phone:801-851-7191
Mailing Address - Fax:801-851-7102
Practice Address - Street 1:151 S UNIVERSITY AVE
Practice Address - Street 2:SUITE 1500
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-4427
Practice Address - Country:US
Practice Address - Phone:801-851-7191
Practice Address - Fax:801-851-7102
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5276714-6006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)