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General NPI Number Information
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NPI Number | 1487247128
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Entity Type | Individual
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Provider Name | STACIE L. RASMUSSEN LMFT
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Gender | Female
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Dates
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Enumeration Date | 02/13/2021
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Last Update Date | 02/13/2021
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Provider Practice Location Address
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Address Line | 5685 S 1475 E STE 3B
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City | OGDEN
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State | UT
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Zip | 84403-4836
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Country | US
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Telephone | 801-791-4538
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Fax |
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Provider Business Mailing Address
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Address Line | 3543 SUNRISE CIR
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City | MOUNTAIN GREEN
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State | UT
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Zip | 84050-6741
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Country | US
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Telephone | 801-791-4538
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 11001131-3902
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License Number State | UT
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