Provider Demographics
NPI:1891936571
Name:MURRAY, LISA MICHELLE (MED)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:MURRAY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43186 KATAMA SQ
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-4471
Mailing Address - Country:US
Mailing Address - Phone:703-963-4739
Mailing Address - Fax:703-542-2130
Practice Address - Street 1:43186 KATAMA SQ
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-4471
Practice Address - Country:US
Practice Address - Phone:703-963-4739
Practice Address - Fax:703-542-2130
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst