Individual
STEPHANIE CHURCH KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ACMHC
Contact information
Practice address
1108 W SOUTH JORDAN PKWY STE B, SOUTH JORDAN, UT 84095-5505
(385) 215-9084
Mailing address
1108 W SOUTH JORDAN PKWY STE B, SOUTH JORDAN, UT 84095-5505
(385) 215-9084
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
128447186009
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
128447186009
STATE LICENSE NUMBER
UT
Enumeration date
07/20/2022
Last updated
07/20/2022
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