Provider Demographics
NPI:1114632742
Name:MURRAY, SHANTELL L
Entity Type:Individual
Prefix:
First Name:SHANTELL
Middle Name:L
Last Name:MURRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 LOGAN ST SE
Mailing Address - Street 2:
Mailing Address - City:HARLOWTON
Mailing Address - State:MT
Mailing Address - Zip Code:59036-5193
Mailing Address - Country:US
Mailing Address - Phone:406-380-1164
Mailing Address - Fax:
Practice Address - Street 1:410 LOGAN ST SE
Practice Address - Street 2:
Practice Address - City:HARLOWTON
Practice Address - State:MT
Practice Address - Zip Code:59036-5193
Practice Address - Country:US
Practice Address - Phone:406-380-1164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-ACLC-LIC-62227101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)