Provider Demographics
NPI:1851842785
Name:JUDD, HEATHER ANN (LCMHC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:JUDD
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 E MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3320
Mailing Address - Country:US
Mailing Address - Phone:801-440-9833
Mailing Address - Fax:
Practice Address - Street 1:684 E VINE ST STE 4A
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5540
Practice Address - Country:US
Practice Address - Phone:801-440-9833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8600111-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health