MEDICARE: BRIAN MURDOCK LCMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	4905198-6004	UT
2	101YP2500X	Professional Counselor	4905198-6004	UT

General Provider Information

NPI Number	:	1932423522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN MURDOCK LCMHC

Provider Business Mailing Address
First Line	:	PO BOX 95666
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-0666
Country	:	US
Telephone Number	:	801-842-2182
Fax Number	:

Provider Business Practice Location Address
First Line	:	7105 S HIGHLAND DR STE 202
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-7321
Country	:	US
Telephone Number	:	385-246-3455
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2010
Last Update Date	:	05/15/2024

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