Healthcare Provider Details

I. General information

NPI: 1992061360
Provider Name (Legal Business Name): STEPHANIE STEVENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 N 200 W STE 300
PROVO UT
84601-1690
US

IV. Provider business mailing address

750 N 200 W STE 300
PROVO UT
84601-1690
US

V. Phone/Fax

Practice location:
  • Phone: 801-373-4760
  • Fax:
Mailing address:
  • Phone: 801-373-4760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10448860-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: