Active NPI
Thomas Evan Mullaly, PSS
- Peer Specialist
- Salt Lake City, UT
National Provider Identifier
1669983417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 796
- Practice address
- 411 N Grant St
Salt Lake City, UT 84116-2725 - Phone
- (801) 359-8862
- NPI assigned
- Oct 19, 2017
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 796 | UT | Primary |
Addresses
Primary practice location
411 N Grant St
Salt Lake City, UT 84116-2725
Mailing address
659 E 800 S Apt B5
Salt Lake City, UT 84102-3539
Phone (801) 759-8145
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 |
|---|---|---|---|
| 796 | UT | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508371200000",
"number": "1669983417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "659 E 800 S APT B5",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841023539",
"telephone_number": "801-759-8145"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 N GRANT ST",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841162725",
"telephone_number": "801-359-8862"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLALY",
"first_name": "THOMAS",
"middle_name": "EVAN",
"credential": "PSS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-10-19",
"last_updated": "2017-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "UT",
"license": "796",
"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 Oct 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.