Provider Demographics
NPI:1306014105
Name:FLORIDA STATE UNIVERSITY
Entity Type:Organization
Organization Name:FLORIDA STATE UNIVERSITY
Other - Org Name:FSU-ECAP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROFESSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:850-770-2251
Mailing Address - Street 1:4750 COLLEGIATE DR
Mailing Address - Street 2:FSU-ECAP FLORIDA STATE UNIVERSITY
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-1000
Mailing Address - Country:US
Mailing Address - Phone:850-770-2241
Mailing Address - Fax:
Practice Address - Street 1:4750 COLLEGIATE DR
Practice Address - Street 2:ABOVE ALL FLORIDA STATE UNIVERSITY
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-1000
Practice Address - Country:US
Practice Address - Phone:850-770-2241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health