Provider Demographics
NPI:1003520297
Name:MURDOCK, SAVANAH (CBT/RBT)
Entity Type:Individual
Prefix:
First Name:SAVANAH
Middle Name:
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:CBT/RBT
Other - Prefix:
Other - First Name:SAVANAH
Other - Middle Name:
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CBT/RBT
Mailing Address - Street 1:10817 206TH ST E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-8841
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10817 206TH ST E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8841
Practice Address - Country:US
Practice Address - Phone:253-861-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61081867106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2098232Medicaid