Provider Demographics
NPI:1457626723
Name:MACKAY, ADAM ROSS (LCSW)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:ROSS
Last Name:MACKAY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT328947-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTVC0000164309OtherVENDOR NUMBER WITH UTAH STATE OFFICE OF REHABILITATION