Provider Demographics
NPI:1306144761
Name:MUIRBROOK, WENDY (LMFT)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:MUIRBROOK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 ENSIGN CT
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-4743
Mailing Address - Country:US
Mailing Address - Phone:801-558-8485
Mailing Address - Fax:
Practice Address - Street 1:11075 S STATE ST STE 28
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5176
Practice Address - Country:US
Practice Address - Phone:801-558-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT352097-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist