Provider Demographics
NPI:1124858030
Name:HELDIBRIDLE, ADAM LANE
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:LANE
Last Name:HELDIBRIDLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 S 300 W
Mailing Address - Street 2:
Mailing Address - City:SANTAQUIN
Mailing Address - State:UT
Mailing Address - Zip Code:84655-8192
Mailing Address - Country:US
Mailing Address - Phone:435-633-0412
Mailing Address - Fax:
Practice Address - Street 1:870 W CENTER ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-5202
Practice Address - Country:US
Practice Address - Phone:435-633-0412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12985283-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical