Provider Demographics
NPI:1710078324
Name:MCMURRY, MARTHA A (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:A
Last Name:MCMURRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-2624
Mailing Address - Country:US
Mailing Address - Phone:573-431-6580
Mailing Address - Fax:573-431-6580
Practice Address - Street 1:512 EAST MAIN ST.
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601
Practice Address - Country:US
Practice Address - Phone:573-431-3341
Practice Address - Fax:573-431-6580
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499674513Medicaid