Provider Demographics
NPI:1720587397
Name:MURRAY, MARISA (LPC)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:MURRAY
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 1:779 ROAD 260
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:KS
Mailing Address - Zip Code:66835-9507
Mailing Address - Country:US
Mailing Address - Phone:620-794-9891
Mailing Address - Fax:
Practice Address - Street 1:1420 C OF E DR FL 2
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2556
Practice Address - Country:US
Practice Address - Phone:620-794-9891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3167101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health