Provider Demographics
NPI:1073969572
Name:JORDAN-MURRAY, ALISHA (LISW)
Entity Type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:
Last Name:JORDAN-MURRAY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 SKINNER DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45426-3442
Mailing Address - Country:US
Mailing Address - Phone:937-395-4600
Mailing Address - Fax:937-395-4610
Practice Address - Street 1:605 S PATTERSON BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2649
Practice Address - Country:US
Practice Address - Phone:937-395-4600
Practice Address - Fax:937-395-4610
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0051101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2847343Medicaid