Provider Demographics
NPI:1407112675
Name:MURPHY, KATELIN ANN (MS, LPC, LPCC, ATR)
Entity Type:Individual
Prefix:
First Name:KATELIN
Middle Name:ANN
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MS, LPC, LPCC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 VISTA BLVD # 143
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4559
Mailing Address - Country:US
Mailing Address - Phone:262-470-0432
Mailing Address - Fax:
Practice Address - Street 1:712 VISTA BLVD # 143
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-4559
Practice Address - Country:US
Practice Address - Phone:262-470-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2412101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1407112675OtherNPI TYPE 1