Provider Demographics
NPI:1801620687
Name:WORTHEN, STACEE J (ASSOC CMHC)
Entity type:Individual
Prefix:
First Name:STACEE
Middle Name:J
Last Name:WORTHEN
Suffix:
Gender:F
Credentials:ASSOC CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3577 W VISTA PRADERA WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-9250
Mailing Address - Country:US
Mailing Address - Phone:801-884-9820
Mailing Address - Fax:
Practice Address - Street 1:2940 W MAPLE LOOP DR STE 204
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5662
Practice Address - Country:US
Practice Address - Phone:857-264-0418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13768636-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health