Provider Demographics
NPI:1275132920
Name:MURRAY, KIMBERLY SUZANNE FERGUSON
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUZANNE FERGUSON
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 1:1635 FOXTRAIL DR STE 121
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9086
Mailing Address - Country:US
Mailing Address - Phone:970-460-8015
Mailing Address - Fax:
Practice Address - Street 1:1635 FOXTRAIL DR STE 121
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9086
Practice Address - Country:US
Practice Address - Phone:970-460-8015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLMFT1576106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLMFT1576OtherDEPARTMENT OF REGULATORY AGENCIES