Provider Demographics
NPI:1144399569
Name:MURPHY, GLEN LOUIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:LOUIS
Last Name:MURPHY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 E SUNDEW DR
Mailing Address - Street 2:
Mailing Address - City:ROLLING PRAIRIE
Mailing Address - State:IN
Mailing Address - Zip Code:46371-9684
Mailing Address - Country:US
Mailing Address - Phone:219-778-4394
Mailing Address - Fax:
Practice Address - Street 1:3455 E SUNDEW DR
Practice Address - Street 2:
Practice Address - City:ROLLING PRAIRIE
Practice Address - State:IN
Practice Address - Zip Code:46371-9684
Practice Address - Country:US
Practice Address - Phone:219-778-4394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010389A103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11607730OtherCAQH
IN20010389AOtherPSYCHOLOGIST LICENSE