Provider Demographics
NPI:1114696614
Name:MURILLO, MAGDA PATRICIA (RMHCI)
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:PATRICIA
Last Name:MURILLO
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7244 WINNERS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-5172
Mailing Address - Country:US
Mailing Address - Phone:863-852-4491
Mailing Address - Fax:
Practice Address - Street 1:7244 WINNERS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-5172
Practice Address - Country:US
Practice Address - Phone:863-852-4491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH19515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty