Provider Demographics
NPI:1255018420
Name:MURRY, TOMIKA ROSCHELLE (LLPC)
Entity type:Individual
Prefix:MRS
First Name:TOMIKA
Middle Name:ROSCHELLE
Last Name:MURRY
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24320 RENSSELAER ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1781
Mailing Address - Country:US
Mailing Address - Phone:248-808-9394
Mailing Address - Fax:
Practice Address - Street 1:24320 RENSSELAER ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1781
Practice Address - Country:US
Practice Address - Phone:313-444-3557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451019245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health