Ketamine for Depression Salt Lake City LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

KETAMINE FOR DEPRESSION SALT LAKE CITY LLC

Doing business as

KetamineSLC

Practice address

201 E 5900 S Ste 200
Murray, UT 84107-5432

Phone

(385) 474-6946

Fax

(385) 355-2782

NPI assigned

Jan 3, 2025

Organization subpart

No

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

Authorized official

Name

Mr. Nicolas Salomon Jr.

Title

Director

Phone

(385) 474-6946

Specialties & licenses 2

Addresses

Other names 1

• KetamineSLC Doing business as

Locations

Practitioners 1

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

• Michelle Lancaster

  • Family Nurse Practitioner
  • Murray, UT
  • NPI 1265049811
  NPD

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

{
    "created_epoch": "1735862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735862400000",
    "number": "1477362465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E 5900 S STE 200",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841075432",
            "telephone_number": "385-474-6946",
            "fax_number": "385-355-2782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E 5900 S STE 200",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841075432",
            "telephone_number": "385-474-6946",
            "fax_number": "385-355-2782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE FOR DEPRESSION SALT LAKE CITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-03",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A",
        "authorized_official_last_name": "SALOMON",
        "authorized_official_first_name": "NICOLAS",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "385-474-6946",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KetamineSLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bruce R. Kenwood, DO
• Hyrum John Kerbs, CSFA
• Michaela Diane Sims Kerby
• Michael Kershaw, DC
• Amy Kershisnik, CSW
• Aric Leon Ketcham, P.T.A.
• Alicen Kettenring
• Morgan Amy Ketterling, DO
• Taylor Kevern
• Dennis M Keyes, MSN, APRN, FNP-C

• Mental Health Clinic/Center (Including Community Mental Health Center) in Murray, UT
• Providers in Murray, UT by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; 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.