Provider Demographics
NPI:1912291865
Name:MURDOCH, SHIRLEY B (MS)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:B
Last Name:MURDOCH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4434 REDDING RD
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8820
Mailing Address - Country:US
Mailing Address - Phone:208-765-3537
Mailing Address - Fax:208-765-3537
Practice Address - Street 1:4434 REDDING RD
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8820
Practice Address - Country:US
Practice Address - Phone:208-765-3537
Practice Address - Fax:208-765-3537
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005031101YM0800X
IDLPC784101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health