1316204720 NPI number — MACKAY COUNSELING, LCSW, PLLC

Table of content: (NPI 1316204720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316204720 NPI number — MACKAY COUNSELING, LCSW, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MACKAY COUNSELING, LCSW, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316204720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
582 RIGBY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84025-4404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-414-5894
Provider Business Mailing Address Fax Number:
801-451-5073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
447 N 300 W STE 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAYSVILLE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84037-4203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-414-5894
Provider Business Practice Location Address Fax Number:
801-451-5073
Provider Enumeration Date:
04/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MACKAY
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
ROSS
Authorized Official Title or Position:
SOCIAL WORKER
Authorized Official Telephone Number:
801-414-5894

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  3289473501 , 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)

  • Identifier: VC0000164309 . This is a "VENDOR NUMBER TO PROVIDE SERVICES FOR VOCATIONAL REHABILITATION CLIENTS IN UTAH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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