Organization
SUMMIT COUNTY CLUBHOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER MACKAY SSW (EXECUTIVE DIRECTOR)
(801) 930-0277
Entity
Organization
Contact information
Practice address
1283 DEER VALLEY DR, PARK CITY, UT 84060-5182
(801) 930-0277
Mailing address
PO BOX 680861, PARK CITY, UT 84068-0861
(801) 930-0277
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003101
—
UT
Enumeration date
09/19/2019
Last updated
11/27/2023
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