Provider Demographics
NPI:1154660843
Name:MURCH, KEVIN BERTRAND (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BERTRAND
Last Name:MURCH
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 1:6812 N OAK TRFY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-2537
Mailing Address - Country:US
Mailing Address - Phone:816-436-0371
Mailing Address - Fax:816-436-0383
Practice Address - Street 1:6812 N OAK TRFY
Practice Address - Street 2:SUITE 1
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-2537
Practice Address - Country:US
Practice Address - Phone:816-436-0371
Practice Address - Fax:816-436-0383
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35200103TF0200X
MO2013004423103TC0700X, 103TF0200X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth