MEDICARE: LISA MURRAY CDCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA	OH
2	390200000X	Student in an Organized Health Care Education/Training Program		OH

General Provider Information

NPI Number	:	1356966964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MURRAY CDCA

Provider Business Mailing Address
First Line	:	6417 MONALISA CT
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-5636
Country	:	US
Telephone Number	:	513-806-0175
Fax Number	:

Provider Business Practice Location Address
First Line	:	3654 WERK RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-4900
Country	:	US
Telephone Number	:	513-549-0417
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2020
Last Update Date	:	06/09/2020

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