Provider Demographics
NPI:1790084903
Name:MURDOCH, GRANT LEE (CMHC)
Entity Type:Individual
Prefix:MR
First Name:GRANT
Middle Name:LEE
Last Name:MURDOCH
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 E 600 N
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-3747
Mailing Address - Country:US
Mailing Address - Phone:801-489-9641
Mailing Address - Fax:
Practice Address - Street 1:698 N 1890 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1327
Practice Address - Country:US
Practice Address - Phone:801-362-6591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6088162-6009101YM0800X
UT6088162-3503104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker