Provider Demographics
NPI:1083340798
Name:MCMURRAY, CARSON
Entity Type:Individual
Prefix:
First Name:CARSON
Middle Name:
Last Name:MCMURRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21429 MONUMENT RD SW
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-6611
Mailing Address - Country:US
Mailing Address - Phone:919-259-2994
Mailing Address - Fax:
Practice Address - Street 1:20110 VASHON HWY SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-6026
Practice Address - Country:US
Practice Address - Phone:206-463-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMCMURCR114ODOtherDRIVERS LICENSE NUMBER