NPIMap

Organization Active NPI

Mount Olympus Counseling Center, Inc.

  • Mental Health Counselor
  • Holladay, UT
National Provider Identifier
1053910331
Registry record updated Oct 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
MOUNT OLYMPUS COUNSELING CENTER, INC.
Practice address
4525 S 2300 E Ste 102
Holladay, UT 84117-4682
Phone
(801) 860-7818
NPI assigned
Oct 19, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kenneth David Roach, ED.D, LCMHCNPI 1619189628
Title
Executive Director
Phone
(801) 792-7028

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X Primary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

4525 S 2300 E Ste 102
Holladay, UT 84117-4682

Mailing address

4525 S 2300 E Ste 102
Holladay, UT 84117-4682
Phone (801) 860-7818

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ken@moccslc.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250714003686 UT Part B Supplier - Clinic/Group Practice 9638684137 Receives reassigned benefits from 1 practitioner
Practice locations: Holladay, UT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603065600000",
    "number": "1053910331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4525 S 2300 E STE 102",
            "city": "HOLLADAY",
            "state": "UT",
            "postal_code": "841174682",
            "telephone_number": "801-860-7818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4525 S 2300 E STE 102",
            "city": "HOLLADAY",
            "state": "UT",
            "postal_code": "841174682",
            "telephone_number": "801-860-7818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT OLYMPUS COUNSELING CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-19",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A",
        "authorized_official_last_name": "ROACH",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "801-792-7028",
        "authorized_official_credential": "ED.D, LCMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ken@moccslc.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "4525 S 2300 E Ste 102",
            "city": "Holladay",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841174682",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Holladay, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.