Provider Demographics
NPI:1114395324
Name:SEARS, STACIE A (CSW)
Entity Type:Individual
Prefix:MS
First Name:STACIE
Middle Name:A
Last Name:SEARS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 W 4700 S
Mailing Address - Street 2:SUITE G1
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-2156
Mailing Address - Country:US
Mailing Address - Phone:801-990-4300
Mailing Address - Fax:
Practice Address - Street 1:1151 E 3900 S
Practice Address - Street 2:SUITE B299
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1216
Practice Address - Country:US
Practice Address - Phone:801-990-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5473800-3502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health