Active NPI
Clair Mellenthin, LCSW
- Mental Health Counselor
- Salt Lake City, UT
National Provider Identifier
1336275478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 5228904-3501
- Practice address
- 1308 S 1700 E Ste 210
Salt Lake City, UT 84108-2273 - Phone
- (801) 949-4524
- Fax
- (801) 355-9614
- NPI assigned
- Feb 25, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 5228904-3501 | UT | Primary |
Addresses
Primary practice location
1308 S 1700 E Ste 210
Salt Lake City, UT 84108-2273
Mailing address
1308 S 1700 E Ste 210
Salt Lake City, UT 84108-2273
Phone (801) 949-4524
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 18, 2024 through Apr 18, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5228904-3501 | UT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1336275478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1308 S 1700 E STE 210",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841082273",
"telephone_number": "801-949-4524",
"fax_number": "801-355-9614"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1308 S 1700 E STE 210",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841082273",
"telephone_number": "801-949-4524",
"fax_number": "801-355-9614"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MELLENTHIN",
"first_name": "CLAIR",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "UT",
"license": "5228904-3501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.