Provider Demographics
NPI:1346299195
Name:MURPHY, MARY (MA LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:COGHILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:965 LIBERTY ST SE
Mailing Address - Street 2:POYAMA COUNSELING SERVICES
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302
Mailing Address - Country:US
Mailing Address - Phone:503-588-2004
Mailing Address - Fax:503-588-2415
Practice Address - Street 1:965 LIBERTY ST SE
Practice Address - Street 2:POYAMA COUNSELING SERVICES
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302
Practice Address - Country:US
Practice Address - Phone:503-588-2004
Practice Address - Fax:503-588-2415
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHT0288106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR042577Medicaid