Stacy Noelani Pettersson, CHMC AND MHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

13811151-6004 Issued in UT

Practice address

3696 W Savannah Cir
West Jordan, UT 84084-1710

Phone

(801) 336-7624

NPI assigned

Mar 23, 2026

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1774224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774224000000",
    "number": "1104764935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 DELANCEY ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100023182",
            "telephone_number": "646-941-7645",
            "fax_number": "929-596-7897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3696 W SAVANNAH CIR",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840841710",
            "telephone_number": "801-336-7624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTERSSON",
        "first_name": "STACY",
        "middle_name": "NOELANI",
        "credential": "CHMC AND MHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-03-23",
        "last_updated": "2026-03-23",
        "certification_date": "2026-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "HI",
            "license": "929",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "13811151-6004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Lyman Peterson, PA-C
• Ryan Paul Peterson, DO
• Edmar Zabrina Petit
• McKenzie Petruzzi
• Ebbonie Anne Pettersson
• Kathleen Denise Pfeffer, MD
• Tina Pham
• Brinnley Shalice Phelon
• Maya Arizona Phillips
• Phoenix Rising Behavior and Academic Consulting LLC

• Mental Health Counselor in West Jordan, UT
• Providers in West Jordan, UT by specialty
• Mental Health Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.