Provider Demographics
NPI:1760254163
Name:STELLIFY TRAUMA THERAPY
Entity Type:Organization
Organization Name:STELLIFY TRAUMA THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENESSA
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:BEAUMONT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-362-7003
Mailing Address - Street 1:20 W 2000 N
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-3501
Mailing Address - Country:US
Mailing Address - Phone:801-362-7003
Mailing Address - Fax:
Practice Address - Street 1:20 W 2000 N
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:UT
Practice Address - Zip Code:84664-3501
Practice Address - Country:US
Practice Address - Phone:801-362-7003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty