Provider Demographics
NPI:1669948196
Name:MURDOCK, KIRK J (LPC)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:J
Last Name:MURDOCK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10764 70TH AVE APT 3204
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-6373
Mailing Address - Country:US
Mailing Address - Phone:912-467-8764
Mailing Address - Fax:
Practice Address - Street 1:10764 70TH AVE APT 3204
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-6373
Practice Address - Country:US
Practice Address - Phone:912-467-8764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health