Provider Demographics
NPI:1467945857
Name:THOMAS L MURRAY JR PHD PLLC
Entity Type:Organization
Organization Name:THOMAS L MURRAY JR PHD PLLC
Other - Org Name:A PATH TO WELLNESS INTEGRATIVE PSYCHI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LESTER
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-604-5100
Mailing Address - Street 1:2711 PINEDALE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:612 N GREENE ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2024
Practice Address - Country:US
Practice Address - Phone:336-604-5100
Practice Address - Fax:336-604-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLMFT1101261QM0801X
NCLPCSS5025261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)