Provider Demographics
NPI:1073901401
Name:MALIN, HEATHER ALLISON
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ALLISON
Last Name:MALIN
Suffix:
Gender:F
Credentials:
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 461224
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:UT
Mailing Address - Zip Code:84746-1224
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:42 NORTH HIDDEN VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:UT
Practice Address - Zip Code:84746
Practice Address - Country:US
Practice Address - Phone:702-275-5305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT139725756004101YM0800X
AZLPC19395101YM0800X
NVCP0213101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health