Basic Information
| Provider Information | |||||||||
| NPI: | 1598194045 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROYHILL | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | CMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 560 BEVERLY AVE | ||||||||
| Address2: | |||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840573704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013598862 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2200 S STATE ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH SALT LAKE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841152724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013598862 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2013 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 12229329-6008 | UT | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | 3514 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 10512 | NC | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 12229329-6004 | UT | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.