Provider Demographics
NPI:1164941829
Name:STOCKER, KATELYN CRYSTAL (CMHC)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:CRYSTAL
Last Name:STOCKER
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 1:60 S MAIN ST UNIT 441
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-3750
Mailing Address - Country:US
Mailing Address - Phone:801-577-5221
Mailing Address - Fax:
Practice Address - Street 1:2363 N HILL FIELD RD
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-6909
Practice Address - Country:US
Practice Address - Phone:801-525-4645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2025-10-09
Deactivation Date:2024-10-12
Deactivation Code:
Reactivation Date:2025-10-09
Provider Licenses
StateLicense IDTaxonomies
UT137131876004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT926727385OtherUNITEDHEALTHCARE