Provider Demographics
NPI:1790921328
Name:MURRAY, BETHANY DIANE (MFT)
Entity Type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:DIANE
Last Name:MURRAY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 MCLEOD DR # 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-2257
Mailing Address - Country:US
Mailing Address - Phone:760-815-5878
Mailing Address - Fax:619-741-5335
Practice Address - Street 1:2774 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1703
Practice Address - Country:US
Practice Address - Phone:760-815-5878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-03
Last Update Date:2009-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVEIN 77-0712809OtherNEVADA CORPORATION NAME: CALLALILY, INC.