Provider Demographics
NPI:1417285560
Name:MURPHY, BRIAN G (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:G
Last Name:MURPHY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1113
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-1113
Mailing Address - Country:US
Mailing Address - Phone:985-893-1678
Mailing Address - Fax:985-234-9252
Practice Address - Street 1:100 S TYLER ST UNIT 7A
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3050
Practice Address - Country:US
Practice Address - Phone:985-893-1678
Practice Address - Fax:985-234-9252
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA507103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1913871Medicaid
LA56364Medicare PIN