Individual
MR. ROBERT STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, CMHC
Contact information
Practice address
750 N FREEDOM BLVD STE 300, PROVO, UT 84601-1690
(801) 373-4760
Mailing address
750 N FREEDOM BLVD STE 300, PROVO, UT 84601-1690
(801) 373-4760
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
11425200-6004
UT
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
900
CA
Other
Enumeration date
06/11/2008
Last updated
01/27/2025
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