Provider Demographics
NPI:1275242679
Name:MCMURTRIE, HAYDEN LIAM THOMAS (LSW)
Entity Type:Individual
Prefix:
First Name:HAYDEN
Middle Name:LIAM THOMAS
Last Name:MCMURTRIE
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:LEAH
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 BEAUMONT DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 BEAUMONT DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4312
Practice Address - Country:US
Practice Address - Phone:765-430-5637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical