Provider Demographics
NPI:1760510127
Name:NEILSON, HEATHER L (LMFT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:NEILSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2228
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84771-2228
Mailing Address - Country:US
Mailing Address - Phone:831-236-8518
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 2228
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84771-2228
Practice Address - Country:US
Practice Address - Phone:831-236-8518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA43011106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist