Carol Sue Kofford

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

65418483501 Issued in UT

Practice address

1700 Park Ave
Ste 2065
Park City, UT 84060-5160

Phone

(435) 659-4508

NPI assigned

May 2, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Carol Sue Messerly Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mind Your Nature

  • Mental Health Counselor
  • Park City, UT
  • NPI 1730420548
  NPD (past)

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

{
    "created_epoch": "1335916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335916800000",
    "number": "1689932154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 PARK AVE",
            "address_2": "STE 2065",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840605160",
            "telephone_number": "435-659-4508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 PARK AVE",
            "address_2": "STE 2065",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840605160",
            "telephone_number": "435-659-4508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOFFORD",
        "first_name": "CAROL",
        "middle_name": "SUE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-02",
        "last_updated": "2012-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "65418483501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROL",
            "last_name": "MESSERLY",
            "middle_name": "SUE",
            "prefix": "MRS.",
            "credential": "LCSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Venssa Riels Knight, D.D.S.
• Jayne Knox
• Alexander Scott Knudsen, CRNA
• Amy S Koch, P.T.A.
• Zachry R Koch, P.T.
• Nathaniel David Kofford, M.D., MSPH
• Brian S. Krachman, D.O.
• Melissa Krajeski, L.AC.
• Wyatt T Krajeski, LICENSED ACU
• Matthew James Krammen, DPT

• Mental Health Counselor in Park City, UT
• Providers in Park City, UT by specialty
• Mental Health Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2012; 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.