Provider Demographics
NPI:1598386179
Name:MOTAGHED, MACKENZIE TAYLOR (LCSW)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:TAYLOR
Last Name:MOTAGHED
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 E MURRAY HOLLADAY RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4567
Mailing Address - Country:US
Mailing Address - Phone:435-659-8440
Mailing Address - Fax:
Practice Address - Street 1:782 E PIONEER RD
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5734
Practice Address - Country:US
Practice Address - Phone:385-202-6324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1238831035011041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker