Provider Demographics
NPI:1689862443
Name:MURPHY, KATHY L (MA)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:L
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PARK ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-1765
Mailing Address - Country:US
Mailing Address - Phone:304-257-1155
Mailing Address - Fax:304-257-1945
Practice Address - Street 1:6 PARK ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-1765
Practice Address - Country:US
Practice Address - Phone:304-257-1155
Practice Address - Fax:304-257-1945
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV283101YM0800X
WV938103T00000X
WVCP004514731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV938OtherLICENSE #
WV283OtherLICENSE #
WVCP00451473OtherLICENSE #