Healthcare Provider Details

I. General information

NPI: 1578325247
Provider Name (Legal Business Name): RILEY MURDOCK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1846 1ST ST # 1011
IDAHO FALLS ID
83401-4415
US

IV. Provider business mailing address

1846 1ST ST # 1011
IDAHO FALLS ID
83401-4415
US

V. Phone/Fax

Practice location:
  • Phone: 208-254-1882
  • Fax:
Mailing address:
  • Phone: 208-254-1882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name: JONATHAN RILEY MURDOCK
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 208-254-1882