Provider Demographics
NPI:1154292852
Name:FELIZ, STACY
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:FELIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 E THREE FOUNTAINS DR UNIT 91
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5250
Mailing Address - Country:US
Mailing Address - Phone:385-267-6291
Mailing Address - Fax:
Practice Address - Street 1:730 E THREE FOUNTAINS DR UNIT 91
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5250
Practice Address - Country:US
Practice Address - Phone:385-267-6291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty