Healthcare Provider Details

I. General information

NPI: 1114434412
Provider Name (Legal Business Name): MACKAY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 RIGBY RD
FARMINGTON UT
84025-4404
US

IV. Provider business mailing address

582 RIGBY RD
FARMINGTON UT
84025-4404
US

V. Phone/Fax

Practice location:
  • Phone: 801-414-5894
  • Fax: 801-451-5073
Mailing address:
  • Phone: 801-414-5894
  • Fax: 801-451-5073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3289473501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number3289473501
License Number StateUT

VIII. Authorized Official

Name: ADAM ROSS MACKAY
Title or Position: MANAGER
Credential: LCSW
Phone: 801-414-5894