Provider Demographics
NPI:1811249774
Name:REDWOOD THERAPY
Entity type:Organization
Organization Name:REDWOOD THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:801-878-4220
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-0064
Mailing Address - Country:US
Mailing Address - Phone:801-878-4220
Mailing Address - Fax:801-878-9846
Practice Address - Street 1:8541 S REDWOOD RD STE C
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9327
Practice Address - Country:US
Practice Address - Phone:801-878-4220
Practice Address - Fax:801-878-9846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty