Provider Demographics
NPI:1053664474
Name:CRANDALL, MICHELLE (CMHC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2577 N 3550 W
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7504
Mailing Address - Country:US
Mailing Address - Phone:801-885-2527
Mailing Address - Fax:
Practice Address - Street 1:740 E 9000 S STE A
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3077
Practice Address - Country:US
Practice Address - Phone:801-822-7170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
UT8912228-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker