Provider Demographics
NPI:1639571953
Name:GITONGA, STEPHEN KIURI (PHD, ACS, LCMHC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:KIURI
Last Name:GITONGA
Suffix:
Gender:M
Credentials:PHD, ACS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5698 S FAIRWOOD DR APT 30
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-3844
Mailing Address - Country:US
Mailing Address - Phone:312-731-8751
Mailing Address - Fax:
Practice Address - Street 1:5667 S REDWOOD RD UNIT 6B
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5495
Practice Address - Country:US
Practice Address - Phone:801-979-1351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8059473-6004101YM0800X
KY0988101YP2500X
ID3440101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional