Organization
MMTC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHERINE ROSE CHENGAPPA SSW (CEO)
(801) 425-2679
Entity
Organization
Contact information
Practice address
1411 W 1100 N, SALT LAKE CITY, UT 84116-1634
(801) 425-2679
Mailing address
1411 W 1100 N, SALT LAKE CITY, UT 84116-1634
(801) 425-2679
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093173510
—
UT
Enumeration date
02/08/2019
Last updated
02/08/2019
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