Provider Demographics
NPI:1114186202
Name:CARBAJAL, STEPHANIE (LMFT, RPT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:CARBAJAL
Suffix:
Gender:F
Credentials:LMFT, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1272
Mailing Address - Country:US
Mailing Address - Phone:801-989-3488
Mailing Address - Fax:801-989-5861
Practice Address - Street 1:375 N MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1272
Practice Address - Country:US
Practice Address - Phone:801-989-3488
Practice Address - Fax:801-989-5861
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6726981-3902106H00000X
MI4101006533106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist