Provider Demographics
NPI:1427608421
Name:FORTY-FIVE DEGREES, P.C.
Entity type:Organization
Organization Name:FORTY-FIVE DEGREES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:DYEANN
Authorized Official - Last Name:HOYAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-616-9459
Mailing Address - Street 1:13533 S WILD BROOK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-2380
Mailing Address - Country:US
Mailing Address - Phone:801-616-9459
Mailing Address - Fax:
Practice Address - Street 1:13533 S WILD BROOK DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-2380
Practice Address - Country:US
Practice Address - Phone:801-616-9459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT311424-2501OtherSTATE LICENSE