Provider Demographics
NPI:1619209020
Name:MURRAY, KENNETH CHARLES (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CHARLES
Last Name:MURRAY
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 1:451 CALLAHAN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-9159
Mailing Address - Country:US
Mailing Address - Phone:740-288-4654
Mailing Address - Fax:740-288-4654
Practice Address - Street 1:451 CALLAHAN RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9159
Practice Address - Country:US
Practice Address - Phone:740-288-4654
Practice Address - Fax:740-288-4654
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE. 0002046 SUPV101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)