Active NPI
Kristi Riecker
- Mental Health Counselor
- Midvale, UT
National Provider Identifier
1154065258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 11220410-6004
- Practice address
- 7494 Southcrest Cir
Midvale, UT 84047-5112 - Phone
- (516) 587-9602
- NPI assigned
- Apr 25, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 11220410-6004 | UT | Primary |
Addresses
Primary practice location
7494 Southcrest Cir
Midvale, UT 84047-5112
Mailing address
7494 Southcrest Cir
Midvale, UT 84047-5112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11220410-6004 | UT | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Outback Therapeutic Expeditions | Past | Accepting new patients | |
| Outback Therapeutic Expeditions | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710374400000",
"number": "1154065258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7494 SOUTHCREST CIR",
"city": "MIDVALE",
"state": "UT",
"postal_code": "840475112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7494 SOUTHCREST CIR",
"city": "MIDVALE",
"state": "UT",
"postal_code": "840475112",
"telephone_number": "516-587-9602"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIECKER",
"first_name": "KRISTI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-04-25",
"last_updated": "2024-03-14",
"certification_date": "2024-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "UT",
"license": "11220410-6004",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Midvale, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.