Healthcare Provider Details

I. General information

NPI: 1912756297
Provider Name (Legal Business Name): MCKENZIE BLAKELY MAY CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BLAKELY MAY CMHC

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 E 11400 S # 121
SANDY UT
84070-6705
US

IV. Provider business mailing address

63 E 11400 S # 121
SANDY UT
84070-6705
US

V. Phone/Fax

Practice location:
  • Phone: 801-717-9230
  • Fax:
Mailing address:
  • Phone: 801-717-9230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13996437-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: