Provider Demographics
NPI:1295315901
Name:MACKAY, RICHARD THOMAS (CMHC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:THOMAS
Last Name:MACKAY
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 PEACHWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEBER
Mailing Address - State:UT
Mailing Address - Zip Code:84405-9464
Mailing Address - Country:US
Mailing Address - Phone:801-866-7321
Mailing Address - Fax:
Practice Address - Street 1:2434 PEACHWOOD WAY
Practice Address - Street 2:
Practice Address - City:SOUTH WEBER
Practice Address - State:UT
Practice Address - Zip Code:84405-9464
Practice Address - Country:US
Practice Address - Phone:801-866-7321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10354857-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty