Provider Demographics
NPI:1720103070
Name:MORRELL, MALISSA ANNE (LMFT, ATR-BC)
Entity Type:Individual
Prefix:MISS
First Name:MALISSA
Middle Name:ANNE
Last Name:MORRELL
Suffix:
Gender:F
Credentials:LMFT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 E VINE ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1738
Mailing Address - Country:US
Mailing Address - Phone:801-875-0312
Mailing Address - Fax:
Practice Address - Street 1:1220 E VINE ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-1738
Practice Address - Country:US
Practice Address - Phone:801-875-0312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8470183-3902106H00000X
CAMFC 47656106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist