Healthcare Provider Details

I. General information

NPI: 1053664474
Provider Name (Legal Business Name): MICHELLE CRANDALL CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 E 9000 S STE A
SANDY UT
84094-3077
US

IV. Provider business mailing address

2577 N 3550 W
LEHI UT
84043-7504
US

V. Phone/Fax

Practice location:
  • Phone: 801-822-7170
  • Fax:
Mailing address:
  • Phone: 801-885-2527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8912228-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: