Healthcare Provider Details

I. General information

NPI: 1255176269
Provider Name (Legal Business Name): STRESSOUT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/01/2024
Certification Date: 06/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S MAIN ST STE 100C
CENTERVILLE UT
84014-1846
US

IV. Provider business mailing address

1025 OAKRIDGE DR
CENTERVILLE UT
84014-1667
US

V. Phone/Fax

Practice location:
  • Phone: 801-923-2063
  • Fax:
Mailing address:
  • Phone: 385-394-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name: SERENITY L HALE
Title or Position: CLINICAL MENTAL HEALTH COUNSELOR
Credential: CMHC
Phone: 801-823-2063