Provider Demographics
NPI:1568660108
Name:OBRIEN, STEPHANIE (PC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:TOPOLOVEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PC
Mailing Address - Street 1:650 KOMAS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1241
Mailing Address - Country:US
Mailing Address - Phone:801-585-9097
Mailing Address - Fax:801-581-8979
Practice Address - Street 1:650 KOMAS DR STE 200
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84108-1241
Practice Address - Country:US
Practice Address - Phone:801-585-9097
Practice Address - Fax:801-581-8979
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5580127-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health