Provider Demographics
NPI:1821662750
Name:MOUNTAIN METTA PSYCHIATRY, LLC
Entity Type:Organization
Organization Name:MOUNTAIN METTA PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKEY WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-396-0401
Mailing Address - Street 1:1785 E 1450 S STE 360
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-2354
Mailing Address - Country:US
Mailing Address - Phone:801-396-0401
Mailing Address - Fax:801-406-1062
Practice Address - Street 1:1785 E 1450 S STE 360
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-2354
Practice Address - Country:US
Practice Address - Phone:801-396-0401
Practice Address - Fax:801-406-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-15
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty