Provider Demographics
NPI:1073809489
Name:DAVIS, STACEY (DOULA, CMA)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DOULA, CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 867
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-0867
Mailing Address - Country:US
Mailing Address - Phone:435-637-7200
Mailing Address - Fax:
Practice Address - Street 1:575 E. 100 S.
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501
Practice Address - Country:US
Practice Address - Phone:435-637-2358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
UT5425606-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No374J00000XNursing Service Related ProvidersDoula