Provider Demographics
NPI:1316204720
Name:MACKAY COUNSELING, LCSW, PLLC
Entity Type:Organization
Organization Name:MACKAY COUNSELING, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
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 1:447 N 300 W STE 7
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-4203
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:2012-04-23
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3289473501251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTVC0000164309OtherVENDOR NUMBER TO PROVIDE SERVICES FOR VOCATIONAL REHABILITATION CLIENTS IN UTAH