Provider Demographics
NPI:1184849663
Name:MCMURRAY, MADELINE LEE (LMFT #22348)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:LEE
Last Name:MCMURRAY
Suffix:
Gender:F
Credentials:LMFT #22348
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:95524-0064
Mailing Address - Country:US
Mailing Address - Phone:707-834-0171
Mailing Address - Fax:707-388-1636
Practice Address - Street 1:101 H ST STE J
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6695
Practice Address - Country:US
Practice Address - Phone:707-834-0171
Practice Address - Fax:707-388-1636
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22348106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22348OtherMFC