1. Home
  2. Directory
  3. Utah
  4. West Jordan
  5. Counselor
  6. NPI Profile

STACY NOELANI PETTERSSON CHMC AND MHC
NPI 1104764935
Counselor - Mental Health in West Jordan, UT

Active since March 23, 2026
3696 W SAVANNAH CIR, WEST JORDAN, UT 84084(801) 336-7624 Get Directions Write a Review

NPPES record last updated: March 23, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Stacy Noelani Pettersson Chmc And Mhc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STACY NOELANI PETTERSSON CHMC AND MHC (NPI 1104764935) is an individual mental health provider in West Jordan, Utah, licensed in Utah (13811151-6004) and active in the NPI registry since March 2026.

NPPES Registry Identity

NPI1104764935
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameSTACY NOELANI PETTERSSONCredential: CHMC AND MHC
Location Address3696 W SAVANNAH CIRWest Jordan, UT 84084-1710
Mailing Address85 Delancey StNew York, NY 10002-3182 · (646) 941-7645 · Fax (929) 596-7897
Phone(801) 336-7624
Sole ProprietorYes
Enumeration DateMarch 23, 2026
NPPES CertifiedMarch 23, 2026
✔ NPI 1104764935 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
Licenses✔ Licensed in UT · 13811151-6004✔ Licensed in HI · 929
3696 W SAVANNAH CIR, West Jordan, UT 84084
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Stacy Pettersson's NPI number?

The NPI number for Stacy Pettersson is 1104764935. It was assigned to this individual provider in the NPPES registry on March 23, 2026.

Where is Stacy Pettersson located?

Stacy Pettersson practices at 3696 W Savannah Cir, West Jordan, UT 84084. The listed phone number is (801) 336-7624.

What is Stacy Pettersson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for Stacy Pettersson was last updated on March 23, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.