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General NPI Number Information
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NPI Number | 1316204720
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Entity Type | Organization
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Legal Business Name | MACKAY COUNSELING, LCSW, PLLC
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 447 N 300 W STE 7
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City | KAYSVILLE
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State | UT
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Zip | 84037-4203
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Country | US
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Telephone | 801-414-5894
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Fax | 801-451-5073
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Provider Business Mailing Address
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Address Line | 582 RIGBY RD
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City | FARMINGTON
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State | UT
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Zip | 84025-4404
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Country | US
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Telephone | 801-414-5894
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Fax | 801-451-5073
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | ADAM ROSS MACKAY
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Credential | LCSW
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Telephone | 801-414-5894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 3289473501
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License Number State | UT
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