Provider Demographics
NPI:1457590671
Name:STUM, JUSTIN K (LMFT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:K
Last Name:STUM
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 E 700 S
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4023
Mailing Address - Country:US
Mailing Address - Phone:435-574-9193
Mailing Address - Fax:
Practice Address - Street 1:640 E 700 S
Practice Address - Street 2:SUITE 103
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4023
Practice Address - Country:US
Practice Address - Phone:435-574-9193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5617226-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist