Provider Demographics
NPI:1619485729
Name:MURPHY, KIRSTEN ELIZABETH (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ELIZABETH
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:3330 CHASTAIN MEADOWS PKWY NW STE 200
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5881
Practice Address - Country:US
Practice Address - Phone:678-648-7644
Practice Address - Fax:678-882-7040
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000553103K00000X
GA1-19-40489103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-19-40489OtherBCBA CERTIFICATE