Provider Demographics
NPI:1841783503
Name:MURRAY, JASON MICHAEL (LCDC III)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MICHAEL
Last Name:MURRAY
Suffix:
Gender:M
Credentials:LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2419
Mailing Address - Country:US
Mailing Address - Phone:513-559-2900
Mailing Address - Fax:513-559-9837
Practice Address - Street 1:3009 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2419
Practice Address - Country:US
Practice Address - Phone:513-559-2900
Practice Address - Fax:513-559-9837
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151023101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)