Provider Demographics
NPI:1730326919
Name:HERITAGE COUNSELING, PLLC
Entity type:Organization
Organization Name:HERITAGE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:NEWBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-525-6975
Mailing Address - Street 1:1747 HERITAGE LN STE B103
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-8546
Mailing Address - Country:US
Mailing Address - Phone:801-525-6975
Mailing Address - Fax:801-525-6988
Practice Address - Street 1:1747 HERITAGE LN STE B103
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-8546
Practice Address - Country:US
Practice Address - Phone:801-525-6975
Practice Address - Fax:801-525-6988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6810992-0162302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization