NPIMap

Organization Active NPI

Kaizen Center for Mental Health PLLC

  • Clinical Social Worker
  • Murray, UT
National Provider Identifier
1134616899
Registry record updated Apr 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
94280933501 Issued in UT
Legal business name
KAIZEN CENTER FOR MENTAL HEALTH PLLC
Practice address
4055 S 700 E Ste 103
Murray, UT 84107-2508
Phone
(801) 712-1790
NPI assigned
Apr 18, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2018

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

Authorized official

Name
Michael Wickersham
Title
Provider/Owner
Phone
(801) 712-1790

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 94280933501 UT Primary

Addresses

Primary practice location

4055 S 700 E Ste 103
Murray, UT 84107-2508

Mailing address

4055 S 700 E Ste 103
Murray, UT 84107-2508

National Provider Directory

National Provider Directory

Locations

4505 S Wasatch Blvd
Ste 260
Salt Lake City, UT 84124
Phone (801) 416-0862

Practitioners & affiliated clinicians

Practitioners 3

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": "1524009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524009600000",
    "number": "1134616899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4055 S 700 E STE 103",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841072508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 S 700 E STE 103",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841072508",
            "telephone_number": "801-712-1790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAIZEN CENTER FOR MENTAL HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-18",
        "last_updated": "2018-04-18",
        "status": "A",
        "authorized_official_last_name": "WICKERSHAM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "801-712-1790"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "94280933501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murray, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.