Provider Demographics
NPI:1780224303
Name:MURRAY, KATHERINE TERESA (BCABA)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:TERESA
Last Name:MURRAY
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:TERESA
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCABA
Mailing Address - Street 1:4100 N MARINE DR APT 4D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2315
Mailing Address - Country:US
Mailing Address - Phone:949-545-8352
Mailing Address - Fax:
Practice Address - Street 1:4100 N MARINE DR APT 4D
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2315
Practice Address - Country:US
Practice Address - Phone:949-545-8352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-11
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0-19-10512103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst