Provider Demographics
NPI:1437535762
Name:MURRAY, NICHOLE (LICSW)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 133RD LN NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-7343
Mailing Address - Country:US
Mailing Address - Phone:952-484-7734
Mailing Address - Fax:
Practice Address - Street 1:2800 CHICAGO AVE STE 250
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1355
Practice Address - Country:US
Practice Address - Phone:612-863-4096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MN206491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical