Provider Demographics
NPI:1023094174
Name:MURRAY, BETHANY ANN (PHD, PMHCNS-BC)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANN
Last Name:MURRAY
Suffix:
Gender:F
Credentials:PHD, PMHCNS-BC
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:ANN
Other - Last Name:DECKARD-CROUCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:550 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2165
Mailing Address - Country:US
Mailing Address - Phone:812-333-6324
Mailing Address - Fax:812-331-6700
Practice Address - Street 1:550 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2165
Practice Address - Country:US
Practice Address - Phone:812-333-6324
Practice Address - Fax:812-331-6700
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000008A364SP0808X
IN70000008364SP0807X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200071220AMedicaid
000000327240OtherANTHEM
000000327240OtherANTHEM
S15152Medicare UPIN