Provider Demographics
NPI:1255176269
Name:STRESSOUT PLLC
Entity type:Organization
Organization Name:STRESSOUT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SERENITY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:801-823-2063
Mailing Address - Street 1:1025 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-1667
Mailing Address - Country:US
Mailing Address - Phone:385-394-9070
Mailing Address - Fax:
Practice Address - Street 1:25 S MAIN ST STE 100C
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-1846
Practice Address - Country:US
Practice Address - Phone:801-923-2063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty