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NPI Code Detail

MEDICARE: STACIE SEARS LLC

MEDICARE: STACIE SEARS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency
2251S00000XCommunity/Behavioral Health Agency5473800-3501UT

General Provider Information

NPI Number : 1336652718
Entity Type Code : Organization
Provider Name (Legal Business Name) : STACIE SEARS LLC
Provider Business Mailing Address
First Line : 2126 S YUMA ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84109-1107
Country : US
Telephone Number : 385-240-4505
Fax Number :
Provider Business Practice Location Address
First Line : 2319 S FOOTHILL DR STE 180
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84109-5403
Country : US
Telephone Number : 385-240-4505
Fax Number :
Authorized Official
Title or Position : OWNER/PSYCHOTHERAPIST
Name : STACIE A. SEARS
Credential : LCSW
Telephone Number : 385-240-4505
Provider Enumeration Date : 11/08/2017
Last Update Date : 03/21/2018

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Directions to “STACIE SEARS LLC ” Practice Location

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