Provider Demographics
NPI:1740962794
Name:MURRAY, BRUCE LYNAIL JR (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:LYNAIL
Last Name:MURRAY
Suffix:JR
Gender:M
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:BRUCE
Other - Middle Name:LYNAIL
Other - Last Name:MURRAY
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:BEHAVIOR TECHNICIAN
Mailing Address - Street 1:1 DUNWOODY PARK STE 220
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 DUNWOODY PARK STE 220
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-7404
Practice Address - Country:US
Practice Address - Phone:470-702-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 103TC2200X
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent