Provider Demographics
NPI:1578095683
Name:STAMBAUGH, LEIGH ANN (CMHC)
Entity Type:Individual
Prefix:
First Name:LEIGH ANN
Middle Name:
Last Name:STAMBAUGH
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 1:1031 S BLUFF ST # 130
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5206
Mailing Address - Country:US
Mailing Address - Phone:435-359-9969
Mailing Address - Fax:
Practice Address - Street 1:1031 S BLUFF ST # 130
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5206
Practice Address - Country:US
Practice Address - Phone:435-359-9969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9257815-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health