Provider Demographics
NPI:1104688571
Name:MCMURTRY, YAWANA
Entity type:Individual
Prefix:
First Name:YAWANA
Middle Name:
Last Name:MCMURTRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12239 W DEARBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3841
Mailing Address - Country:US
Mailing Address - Phone:414-364-2911
Mailing Address - Fax:
Practice Address - Street 1:12239 W DEARBOURN AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3841
Practice Address - Country:US
Practice Address - Phone:414-364-2911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty