Provider Demographics
NPI:1114434412
Name:MACKAY COUNSELING
Entity Type:Organization
Organization Name:MACKAY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:MACKAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-414-5894
Mailing Address - Street 1:582 RIGBY RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-4404
Mailing Address - Country:US
Mailing Address - Phone:801-414-5894
Mailing Address - Fax:801-451-5073
Practice Address - Street 1:582 RIGBY RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-4404
Practice Address - Country:US
Practice Address - Phone:801-414-5894
Practice Address - Fax:801-451-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT32894735011041C0700X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty