Healthcare Provider Details

I. General information

NPI: 1386810851
Provider Name (Legal Business Name): STACIE JOYCE GIBBONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 S 1470 E STE 201
ST GEORGE UT
84790-2762
US

IV. Provider business mailing address

4210 S CAROLEEN WAY
MILLCREEK UT
84124-2507
US

V. Phone/Fax

Practice location:
  • Phone: 435-932-3672
  • Fax:
Mailing address:
  • Phone: 435-632-5135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number141961093902
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: