Healthcare Provider Details

I. General information

NPI: 1760254163
Provider Name (Legal Business Name): STELLIFY TRAUMA THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W 2000 N
MAPLETON UT
84664-3501
US

IV. Provider business mailing address

20 W 2000 N
MAPLETON UT
84664-3501
US

V. Phone/Fax

Practice location:
  • Phone: 801-362-7003
  • Fax:
Mailing address:
  • Phone: 801-362-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JENESSA PAIGE BEAUMONT
Title or Position: THERAPIST
Credential: LCSW
Phone: 801-362-7003