Provider Demographics
NPI:1528358041
Name:MURRAY, BRELIN I
Entity Type:Individual
Prefix:MR
First Name:BRELIN
Middle Name:
Last Name:MURRAY
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11226 S FIGUEROA ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90061-1462
Mailing Address - Country:US
Mailing Address - Phone:323-455-0617
Mailing Address - Fax:
Practice Address - Street 1:2930 W IMPERIAL HWY STE 200M
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-3142
Practice Address - Country:US
Practice Address - Phone:323-754-2989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD8623250101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor