Provider Demographics
NPI:1225813637
Name:STOCKING, STACEY GLENN (CMHC, ASUDC, TRS)
Entity Type:Individual
Prefix:MR
First Name:STACEY
Middle Name:GLENN
Last Name:STOCKING
Suffix:
Gender:M
Credentials:CMHC, ASUDC, TRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 S DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-2016
Mailing Address - Country:US
Mailing Address - Phone:801-231-9592
Mailing Address - Fax:
Practice Address - Street 1:375 RAINBOW LN
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:UT
Practice Address - Zip Code:84049-7001
Practice Address - Country:US
Practice Address - Phone:435-654-1082
Practice Address - Fax:435-654-1482
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT108034-6008101YA0400X
UT108034-4002225800000X
UT108034-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist