Provider Demographics
NPI:1437740487
Name:STAGES FAMILY THERAPY PLLC
Entity Type:Organization
Organization Name:STAGES FAMILY THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:WILLIS
Authorized Official - Last Name:HAGEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-200-2506
Mailing Address - Street 1:2039 E FICUS WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE MTN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-5741
Mailing Address - Country:US
Mailing Address - Phone:801-200-2506
Mailing Address - Fax:
Practice Address - Street 1:4095 E PONY EXPRESS PKWY STE 15
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-5529
Practice Address - Country:US
Practice Address - Phone:801-200-2506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)