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General NPI Number Information
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NPI Number | 1821662750
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Entity Type | Organization
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Legal Business Name | MOUNTAIN METTA PSYCHIATRY, LLC
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Dates
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Enumeration Date | 05/15/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 1785 E 1450 S STE 360
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City | CLEARFIELD
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State | UT
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Zip | 84015-2354
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Country | US
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Telephone | 801-396-0401
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Fax | 801-406-1062
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Provider Business Mailing Address
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Address Line | 1785 E 1450 S STE 360
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City | CLEARFIELD
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State | UT
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Zip | 84015-2354
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Country | US
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Telephone | 801-396-0401
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Fax | 801-406-1062
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Authorized Official
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Title or Position | PSYCHIATRIST/OWNER
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Name | DR. AMBER MACKEY WILSON
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Credential | DO
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Telephone | 801-396-0401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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