Provider Demographics
NPI:1437908662
Name:MUSGRAVE, CANDICE (CMHC-I)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:MUSGRAVE
Suffix:
Gender:F
Credentials:CMHC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 W COYOTE WAY
Mailing Address - Street 2:
Mailing Address - City:DAMMERON VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84783-5048
Mailing Address - Country:US
Mailing Address - Phone:435-256-5314
Mailing Address - Fax:
Practice Address - Street 1:254 S 1470 E STE 201
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2762
Practice Address - Country:US
Practice Address - Phone:435-932-3672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health