MMTC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

MMTC

Practice address

1411 W 1100 N
Salt Lake City, UT 84116-1634

Phone

(801) 425-2679

NPI assigned

Feb 8, 2019

Organization subpart

No

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

Authorized official

Name

Mrs. Katherine Rose Chengappa, SSW

Title

Ceo

Phone

(801) 425-2679

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1549584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549584000000",
    "number": "1689139198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 W 1100 N",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841161634",
            "telephone_number": "801-425-2679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 W 1100 N",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841161634",
            "telephone_number": "801-425-2679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMTC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-08",
        "last_updated": "2019-02-08",
        "status": "A",
        "authorized_official_last_name": "CHENGAPPA",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "801-425-2679",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "SSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093173510",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Isabella Lara Mizels, CPNP-PC
• Joshua E. Mizels, MD
• MLMS Downtown Clinic LC
• MLMS Murray Clinic LC
• MLMS Salt Lake Clinic LC
• Mobile Medical Group PC
• Kevin Scott Mochizuki, PH.D. D.ABNM
• Lance Mochizuki
• Chelsea Mock
• Katelyn Mock, PA-S

• Community/Behavioral Health Agency in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Community/Behavioral Health Agency in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2019; 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.