Healthcare Provider Details

I. General information

NPI: 1053242834
Provider Name (Legal Business Name): ANGELA STEPHENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 N MAIN ST STE 1
SPRINGVILLE UT
84663-4014
US

IV. Provider business mailing address

1220 N MAIN ST STE 1
SPRINGVILLE UT
84663-4014
US

V. Phone/Fax

Practice location:
  • Phone: 385-449-0309
  • Fax:
Mailing address:
  • Phone: 385-449-0309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: