Provider Demographics
NPI:1467641480
Name:DUROSS, AUDREY MULLIKEN (LCSW)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:MULLIKEN
Last Name:DUROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 LOWER EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5254
Mailing Address - Country:US
Mailing Address - Phone:801-910-7193
Mailing Address - Fax:
Practice Address - Street 1:2720 HOMESTEAD RD STE 40
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-4885
Practice Address - Country:US
Practice Address - Phone:801-910-7193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6727018-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical