Provider Demographics
NPI:1760661219
Name:MURRAY, ANN FORDE (MA LCPC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:FORDE
Last Name:MURRAY
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4658
Mailing Address - Country:US
Mailing Address - Phone:630-217-0115
Mailing Address - Fax:
Practice Address - Street 1:5116 FOREST AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-4658
Practice Address - Country:US
Practice Address - Phone:630-217-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional