MEDICARE: STACY DAWN CRANE ACMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	4852953-6009	UT

General Provider Information

NPI Number	:	1437897626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY DAWN CRANE ACMHC

Provider Business Mailing Address
First Line	:	PO BOX 37
Second Line	:
City	:	VERNAL
State	:	UT
Zip	:	84078-0001
Country	:	US
Telephone Number	:	435-790-2757
Fax Number	:	435-789-4045

Provider Business Practice Location Address
First Line	:	1285 W HIGHWAY 40
Second Line	:
City	:	VERNAL
State	:	UT
Zip	:	84078-2923
Country	:	US
Telephone Number	:	435-790-2757
Fax Number	:	435-789-4045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	12/17/2025

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