Provider Demographics
NPI:1780102533
Name:MURRELL, MAYRA (BCBA)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:MURRELL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CENTRAL PARK SQ STE 22
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-4026
Mailing Address - Country:US
Mailing Address - Phone:323-356-6049
Mailing Address - Fax:
Practice Address - Street 1:150 CENTRAL PARK SQ STE 22
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-4026
Practice Address - Country:US
Practice Address - Phone:323-356-6049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16-13230106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician