Healthcare Provider Details

I. General information

NPI: 1952124562
Provider Name (Legal Business Name): ORRIN-PORTER MORRISON MA, PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2024
Last Update Date: 11/02/2024
Certification Date: 11/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 E 12200 S STE G
DRAPER UT
84020-7861
US

IV. Provider business mailing address

365 W PAXTON AVE UNIT 241
SALT LAKE CITY UT
84101-3261
US

V. Phone/Fax

Practice location:
  • Phone: 385-299-8841
  • Fax:
Mailing address:
  • Phone: 385-299-8841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number14018408-2501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number14018408-2501
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number14018408-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: