Provider Demographics
NPI:1972563591
Name:STOLL, ROBERT W (LMFT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:STOLL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 MARKET ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-3783
Mailing Address - Country:US
Mailing Address - Phone:801-815-8699
Mailing Address - Fax:
Practice Address - Street 1:3600 MARKET ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84119-3783
Practice Address - Country:US
Practice Address - Phone:801-815-8699
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49471503902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist