Provider Demographics
NPI:1598970832
Name:MURRAY, MARTELLE ALBERTA (MS LCPC)
Entity Type:Individual
Prefix:MS
First Name:MARTELLE
Middle Name:ALBERTA
Last Name:MURRAY
Suffix:
Gender:F
Credentials:MS LCPC
Other - Prefix:MISS
Other - First Name:MARTELLE
Other - Middle Name:ALBERTA
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6184 HAPPY LANE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686
Mailing Address - Country:US
Mailing Address - Phone:208-631-7972
Mailing Address - Fax:
Practice Address - Street 1:804 3RD STREET SOUTH
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651
Practice Address - Country:US
Practice Address - Phone:208-631-7972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC 3193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDQ5787OtherBLUE CROSS BLUE SHIELD