1922356732 NPI number — STACY LYNN HAMILTON JONES PHD

Table of content: STACY LYNN HAMILTON JONES PHD (NPI 1922356732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922356732 NPI number — STACY LYNN HAMILTON JONES PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
STACY
Provider Middle Name:
LYNN HAMILTON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMILTON
Provider Other First Name:
STACY
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922356732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 353
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84327-0353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-592-9874
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 EAST CENTER STREET, SUITE 205
Provider Second Line Business Practice Location Address:
KEYSTONE FAMILY SOLUTIONS
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-592-9874
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  7089635-3902 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)