Provider Demographics
NPI:1215362827
Name:GRANT, MISTY (PHD, CMHC)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:PHD, CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N TRIUMPH BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5046
Mailing Address - Country:US
Mailing Address - Phone:385-439-8081
Mailing Address - Fax:
Practice Address - Street 1:3300 N TRIUMPH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5046
Practice Address - Country:US
Practice Address - Phone:385-439-8081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8484427-6004101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional