Provider Demographics
NPI:1255682357
Name:MURRAY, KELLY J
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:MURRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4085 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5307
Mailing Address - Country:US
Mailing Address - Phone:321-632-2737
Mailing Address - Fax:321-633-1963
Practice Address - Street 1:4085 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5307
Practice Address - Country:US
Practice Address - Phone:321-632-2737
Practice Address - Fax:321-633-1963
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health