Mackay Dale Shelley
Individual provider Active NPI Counselor · Moroni, UT
NPI 1366816902 · NPPES record last updated Nov 19, 2015
Key facts
- NPI
- 1366816902
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 4800 East 17160 North
Moroni, UT 84646-0028 - Phone
- (435) 436-5321
- Fax
- (435) 436-5322
- NPI assigned
- Nov 19, 2015
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
4800 East 17160 North
Moroni, UT 84646-0028
Mailing address
PO Box 28
Moroni, UT 84646-0028
Phone (435) 436-5321
Other providers in Moroni, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.