Provider Demographics
NPI:1497934103
Name:STEPHENSON, SUE (CMHC)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BROADWAY APT A220
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-5617
Mailing Address - Country:US
Mailing Address - Phone:801-577-1602
Mailing Address - Fax:
Practice Address - Street 1:466 N MAIN ST
Practice Address - Street 2:210
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-3222
Practice Address - Country:US
Practice Address - Phone:801-773-7060
Practice Address - Fax:801-774-6100
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT293249-6004101YM0800X, 101YP2500X
UT293249-3503104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical