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NPI Code Detail

MEDICARE: MRS. AMBER MACKAY

MEDICARE: MRS. AMBER MACKAY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor6583552-3503UT

General Provider Information

NPI Number : 1104124882
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMBER MACKAY
Provider Business Mailing Address
First Line : 1724 S MAIN ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-1912
Country : US
Telephone Number : 801-486-5012
Fax Number : 801-466-5077
Provider Business Practice Location Address
First Line : 1724 S MAIN ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-1912
Country : US
Telephone Number : 801-486-5012
Fax Number : 801-466-5077
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2011
Last Update Date : 07/21/2022

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