Provider Demographics
NPI:1922356732
Name:JONES, STACY LYNN HAMILTON (PHD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN HAMILTON
Last Name:JONES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 353
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:UT
Mailing Address - Zip Code:84327-0353
Mailing Address - Country:US
Mailing Address - Phone:435-592-9874
Mailing Address - Fax:
Practice Address - Street 1:60 EAST CENTER STREET, SUITE 205
Practice Address - Street 2:KEYSTONE FAMILY SOLUTIONS
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321
Practice Address - Country:US
Practice Address - Phone:435-592-9874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7089635-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist