Provider Demographics
NPI:1720883564
Name:STOLL, BRET G (PMHNP)
Entity type:Individual
Prefix:
First Name:BRET
Middle Name:G
Last Name:STOLL
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 E ZION TRL S
Mailing Address - Street 2:
Mailing Address - City:TOQUERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84774-5123
Mailing Address - Country:US
Mailing Address - Phone:503-780-3583
Mailing Address - Fax:
Practice Address - Street 1:1333 S VALLEY GROVE WAY
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-6763
Practice Address - Country:US
Practice Address - Phone:801-683-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12142486-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health