Provider Demographics
NPI:1104044338
Name:MURRAY, JODI MICHELLE (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:MICHELLE
Last Name:MURRAY
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 SHERIDAN PL
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6215
Mailing Address - Country:US
Mailing Address - Phone:406-579-8307
Mailing Address - Fax:406-585-0636
Practice Address - Street 1:321 E MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4731
Practice Address - Country:US
Practice Address - Phone:406-579-8307
Practice Address - Fax:406-585-0636
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1083101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT256490Medicaid