Provider Demographics
NPI:1346620614
Name:MURRAY, SHANNON (MA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1354 CORONET CT APT D
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-5507
Mailing Address - Country:US
Mailing Address - Phone:803-415-9270
Mailing Address - Fax:
Practice Address - Street 1:1354 CORONET CT APT D
Practice Address - Street 2:2025 EBENZER RD STUITE G
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-5507
Practice Address - Country:US
Practice Address - Phone:803-415-9270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health