Provider Demographics
NPI:1700636768
Name:ABEYTA, STEPHANIE (CSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ABEYTA
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7195 S 2530 W
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-3059
Mailing Address - Country:US
Mailing Address - Phone:385-255-6168
Mailing Address - Fax:
Practice Address - Street 1:12523 S PASTURE RD STE 250
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-4842
Practice Address - Country:US
Practice Address - Phone:203-980-1796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12784772-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical