Healthcare Provider Details

I. General information

NPI: 1023536935
Provider Name (Legal Business Name): DR. PORTER MACEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9295 S 1300 E
SANDY UT
84094-3127
US

IV. Provider business mailing address

9295 S 1300 E STE 7
SANDY UT
84094-3127
US

V. Phone/Fax

Practice location:
  • Phone: 801-364-8080
  • Fax: 801-364-8080
Mailing address:
  • Phone: 801-455-0045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number10418270-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: