Provider Demographics
NPI:1851934608
Name:MURPHY, DEDRICK O SR
Entity Type:Individual
Prefix:MR
First Name:DEDRICK
Middle Name:O
Last Name:MURPHY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-4160
Mailing Address - Country:US
Mailing Address - Phone:317-292-5123
Mailing Address - Fax:
Practice Address - Street 1:609 E 29TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-4160
Practice Address - Country:US
Practice Address - Phone:317-292-5123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1720489479Medicaid