Healthcare Provider Details

I. General information

NPI: 1730075755
Provider Name (Legal Business Name): CRAIG HULBERT SUDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5635 S WATERBURY WAY STE C102
MURRAY UT
84121-6217
US

IV. Provider business mailing address

5635 S WATERBURY WAY STE C102
MURRAY UT
84121-6217
US

V. Phone/Fax

Practice location:
  • Phone: 801-473-3963
  • Fax: 801-797-1220
Mailing address:
  • Phone: 801-473-3963
  • Fax: 801-797-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14174896-6006
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: