Provider Demographics
NPI:1932893906
Name:MURRAY, CORETTA JO
Entity Type:Individual
Prefix:
First Name:CORETTA
Middle Name:JO
Last Name:MURRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 CINNAMON RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-6585
Mailing Address - Country:US
Mailing Address - Phone:561-619-0003
Mailing Address - Fax:
Practice Address - Street 1:8390 CHAMPIONS GATE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:CHAMPIONS GATE
Practice Address - State:FL
Practice Address - Zip Code:33896-8311
Practice Address - Country:US
Practice Address - Phone:407-753-7932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician