THOMAS EVAN MULLALY (NPI# 1669983417) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669983417 |
| Entity Type | Individual |
| Full Name | THOMAS EVAN MULLALY |
| Credential | PSS |
| Practice Address |
411 N Grant St Salt Lake City UT 84116-2725 |
| Mailing Address |
659 E 800 S Apt B5 Salt Lake City UT 84102-3539 |
| Practice Telephone | 8013598862 |
| Mailing Telephone | 8017598145 |
| Enumeration Date | 2017-10-19 |
| Last Update Date | 2017-10-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | 796 | UT | Other Service Providers |
| Street Address |
411 N GRANT ST |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84116-2725 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174662282 | Sam Leslie Farris | Counselor | 411 N Grant St, Salt Lake City, UT 84116-2725 | 2007-02-05 |
| 1972144731 | Daisy Elizabeth Mae Lael | Counselor | 411 N Grant St, Salt Lake City, UT 84116-2725 | 2019-10-03 |
| 1871059139 | Joel Arvizo | Case Manager/Care Coordinator | 411 N Grant St, Salt Lake City, UT 84116-2725 | 2019-02-12 |
| 1477023497 | Thomas Childs | Psychologist | 411 N Grant St, Salt Lake City, UT 84116-2725 | 2018-12-03 |
| 1356827315 | Jeanine Kunshek | Case Manager/Care Coordinator | 411 N Grant St, Salt Lake City, UT 84116-2725 | 2018-07-12 |
| 1598250060 | Alex Ryan Stephens | Case Manager/Care Coordinator | 411 N Grant St, Salt Lake City, UT 84116-2725 | 2018-06-27 |
| 1053810648 | Kathryn Anne Tozzi | Social Worker | 411 N Grant St, Salt Lake City, UT 84116-2725 | 2018-02-08 |
| 1750811899 | Shawn Mcmillen | Counselor | 411 N Grant St, Salt Lake City, UT 84116-2725 | 2017-06-12 |
| 1760926562 | Janie Hansen | Social Worker | 411 N Grant St, Salt Lake City, UT 84116-2725 | 2016-12-13 |
| 1720522618 | First Step House | Substance Abuse Rehabilitation Facility | 411 N Grant St, Salt Lake City, UT 84116-2725 | 2016-12-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689281818 | Devery White | Case Manager/Care Coordinator | 195 N 1900 W, Salt Lake City, UT 84116 | 2020-10-01 |
| 1114402377 | Felicia Marie Speer | Community Health Worker | 1303 Sir Phillip Dr, Salt Lake City, UT 84116 | 2018-10-03 |
| 1982144341 | Sharlena Schacht | Pharmacy Technician | 1040 North 2200 West, Salt Lake City, UT 84116 | 2017-03-06 |
| 1316300460 | Riverside Family Dental Care, Inc | Clinic/Center | 1614 W 700 N, Salt Lake City, UT 84116 | 2016-04-05 |
| 1174882856 | Marilyn Ross | Nurse Practitioner | 384 Wright Brothers Dr., Marilyn Ross Bld #2, Salt Lake City, UT 84116 | 2012-05-15 |
| 1720387137 | Lifetime Products Inc. | Durable Medical Equipment & Medical Supplies | 745 N Warm Springs Rd, Salt Lake City, UT 84116 | 2011-03-24 |
| 1811000276 | Kim Coston Christensen | Preventive Medicine | 2150 West 700 North, Kim C. Christensen D.o. Faa Sl/artcc Mfo, Salt Lake City, UT 84116 | 2006-08-17 |
| 1144705583 | Brian Larry Gashler | Family Medicine | 54 N 8th W, Salt Lake City, UT 84116 | 2018-10-02 |
| 1528350972 | Aliesha Shaw | Student in an Organized Health Care Education/Training Program | 26 South 2000 East, 5900, Salt Lake City, UT 84116 | 2011-05-04 |
| 1427035187 | Sarah Lynn Woolsey | Family Medicine | 1365 W 1000 N, Salt Lake City, UT 84116 | 2005-12-23 |
| Find all providers in zip 84116 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043819600 | Devin J Morrison | Peer Specialist | 230 W 200 S Unit 142, Salt Lake City, UT 84110-6006 | 2020-10-23 |
| 1518579077 | Henry Matthews | Peer Specialist | 474 N Grant St, Salt Lake City, UT 84116-2726 | 2020-08-17 |
| 1134780042 | Michael James Olsen | Peer Specialist | 344 E 100 S Ste 301300, Salt Lake City, UT 84111-1700 | 2019-06-23 |
| 1659836393 | Brittney Emi Vaovasa | Peer Specialist | 252 W Brooklyn Ave, Salt Lake City, UT 84101-3024 | 2019-02-06 |
| 1306348263 | Kurt Kyle Landenberger | Peer Specialist | 2200 S State St Fl 2, Salt Lake City, UT 84115-2724 | 2018-03-06 |
| 1922609320 | Teri Christensen | Peer Specialist | 230 W 200 S # 142, Salt Lake City, UT 84101-1337 | 2020-11-03 |
| 1821698713 | Kim Katherine Stephens | Peer Specialist | 230 W 200 S # 142, Salt Lake City, UT 84101-1337 | 2020-10-29 |
| 1225638364 | Anna Elizabeth Dees | Peer Specialist | 230 W 200 S Ste 142, Salt Lake City, UT 84101-1337 | 2020-10-28 |
| 1124628268 | Amber Wilkins I | Peer Specialist | 230 W 200 S # 142, Salt Lake City, UT 84101-1337 | 2020-10-28 |
| 1811596885 | Kaylie A Larsen | Peer Specialist | 230 W 200 S # 142, Salt Lake City, UT 84101-1337 | 2020-10-21 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84116 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.