Provider Demographics
NPI:1932518529
Name:MURPHY, GREGORY
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:MURPHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2494 PENNINGTON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-7841
Mailing Address - Country:US
Mailing Address - Phone:805-782-7340
Mailing Address - Fax:
Practice Address - Street 1:10801 EL CAMINO REAL
Practice Address - Street 2:CHALK MOUNTAIN COMMUNITY SCHOOL
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93423
Practice Address - Country:US
Practice Address - Phone:805-782-7351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-M1407301114101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)