Stacey Glenn Stocking, CMHC, ASUDC, TRS
Individual provider Active NPI Mental Health Counselor · Midway, UT
NPI 1225813637 · NPPES record last updated Aug 25, 2023
Key facts
- NPI
- 1225813637
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 108034-6004 (UT)
- Practice address
- 375 Rainbow LN
Midway, UT 84049-7001 - Phone
- (435) 654-1082
- Fax
- (435) 654-1482
- NPI assigned
- Aug 25, 2023
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 108034-6008 | UT | MD | Addiction (Substance Use Disorder) Counselor |
| 108034-6004 | UT | MD | Mental Health Counselor |
| 108034-4002 | UT | MD | Recreation Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 108034-6008 | UT | |
| Recreation Therapist | 225800000X | 108034-4002 | UT | |
| Mental Health Counselor | 101YM0800X | 108034-6004 | UT | Yes |
Addresses
Primary practice location
375 Rainbow LN
Midway, UT 84049-7001
Mailing address
1060 S Davis Blvd
Bountiful, UT 84010-2016
Phone (801) 231-9592
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All providers in Midway, UT · Mental Health Counselor in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.