Amanda Liesta Masellis, CADC-I, SUDC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

11822780-6006 Issued in UT

Practice address

164 E 5900 S Ste 101
Murray, UT 84107-7256

Phone

(801) 261-5790

Fax

(801) 261-5794

NPI assigned

Jun 29, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

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 and National Provider Directory roles.

• Baymark Health Services of Utah, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Ogden, UT
  • NPI 1982170528
  NPD (past)

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

{
    "created_epoch": "1467158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604620800000",
    "number": "1851742001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 E 5900 S STE 101",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841077256",
            "telephone_number": "801-261-5790",
            "fax_number": "801-261-5794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 E 5900 S STE 101",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841077256",
            "telephone_number": "801-261-5790",
            "fax_number": "801-261-5794"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2060 Campus Dr",
            "address_purpose": "LOCATION",
            "city": "Yreka",
            "state": "CA",
            "postal_code": "960979538",
            "country_code": "US",
            "telephone_number": "530-841-4100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "310 Harris Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "95838",
            "country_code": "US",
            "telephone_number": "916-649-6793 x9031",
            "fax_number": "916-929-7411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MASELLIS",
        "first_name": "AMANDA",
        "middle_name": "LIESTA",
        "name_prefix": "Ms.",
        "credential": "CADC-I,  SUDC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-29",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "CI10940218",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "UT",
            "license": "11822780-6006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Martinez
• Ruth Irene Martinez
• Michael Marty, OD
• Mary Kay Lehto LCSW LLC
• Dorothy Kay Maryon, LPC
• Aleya Marie Mason
• Elizabeth Masm Mason, MD
• Steve Mason, PAC
• Marissa Ann Masten, MTRS, TRS, MS
• Miranda Masters, RDN

• All providers in Murray, UT
• Addiction (Substance Use Disorder) Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.