Provider Demographics
NPI:1932952991
Name:MCKNIGHT, MALLORY (CMHC)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 S 2525 W
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-1036
Mailing Address - Country:US
Mailing Address - Phone:801-648-3520
Mailing Address - Fax:
Practice Address - Street 1:3535 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-4026
Practice Address - Country:US
Practice Address - Phone:385-389-6774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12846742-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health