| Kaizen Center For Mental Health Pllc | |
|
4055 S 700 E Ste 103 Murray UT 84107-2508 | |
| (801) 712-1790 | |
| Not Available |
| Full Name | Kaizen Center For Mental Health Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 4055 S 700 E Ste 103, Murray, Utah |
| Authorized Official Name and Position | Michael Wickersham (PROVIDER/OWNER) |
| Authorized Official Contact | 8017121790 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kaizen Center For Mental Health Pllc 4055 S 700 E Ste 103 Murray UT 84107-2508 Ph: () - | Kaizen Center For Mental Health Pllc 4055 S 700 E Ste 103 Murray UT 84107-2508 Ph: (801) 712-1790 |
| NPI Number | 1134616899 |
|---|---|
| Provider Enumeration Date | 04/18/2018 |
| Last Update Date | 04/18/2018 |
| Medicare PECOS PAC ID | 0143584763 |
|---|---|
| Medicare Enrollment ID | O20180508001210 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134616899 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 94280933501 (Utah) | Primary |
| Provider Name | Michael C Wickersham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932572161 PECOS PAC ID: 4385935931 Enrollment ID: I20160629000520 |
| Provider Name | Molly Quick Mcfadden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184901522 PECOS PAC ID: 4688974330 Enrollment ID: I20191211002998 |
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