Provider Demographics
NPI:1457415655
Name:MURRAY, TIMOTHY (MC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:MURRAY
Suffix:
Gender:M
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-4820
Mailing Address - Country:US
Mailing Address - Phone:520-836-1675
Mailing Address - Fax:520-421-1969
Practice Address - Street 1:120 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-4820
Practice Address - Country:US
Practice Address - Phone:520-836-1675
Practice Address - Fax:520-421-1969
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0014101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ754839Medicaid
AZLPC-0014OtherLICENSE