Provider Demographics
NPI:1205547379
Name:MURPHY, MICHAEL BRODERICK JR (MS, LPC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRODERICK
Last Name:MURPHY
Suffix:JR
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 VICKERY BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3344
Mailing Address - Country:US
Mailing Address - Phone:203-610-9629
Mailing Address - Fax:
Practice Address - Street 1:5710 LYNDON B JOHNSON FWY STE 165
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6572
Practice Address - Country:US
Practice Address - Phone:203-610-9629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86917101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health