Provider Demographics
NPI:1861464315
Name:MURRAY, THOMAS EDWARD (EDD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:MURRAY
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 N BRIARWOOD LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5214
Mailing Address - Country:US
Mailing Address - Phone:765-289-5520
Mailing Address - Fax:765-289-5840
Practice Address - Street 1:3645 N BRIARWOOD LN
Practice Address - Street 2:SUITE A
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5214
Practice Address - Country:US
Practice Address - Phone:765-289-5520
Practice Address - Fax:765-289-5840
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20090170103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100205420Medicaid
IN190100BMedicare PIN
IN062222000OtherMAGELLAN
IN190100BMedicare UPIN