Individual
STACY GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1516 S 1100 E STE A, SALT LAKE CITY, UT 84105-2425
(385) 743-2226
Mailing address
2932 W RETA RIDGE CT, SOUTH JORDAN, UT 84095-1247
(801) 870-1598
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
UT
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
05/10/2018
Last updated
01/27/2022
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