Provider Demographics
NPI:1255331880
Name:MURRAY, KATY (MSW)
Entity Type:Individual
Prefix:MS
First Name:KATY
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3627 ENSIGN RD NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-6104
Mailing Address - Country:US
Mailing Address - Phone:360-438-0306
Mailing Address - Fax:360-493-1697
Practice Address - Street 1:3627 ENSIGN RD NE
Practice Address - Street 2:SUITE B
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5024
Practice Address - Country:US
Practice Address - Phone:360-438-0306
Practice Address - Fax:360-493-1697
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00003510101YA0400X
WALW000047661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
27-1152154OtherEIN