Healthcare Provider Details

I. General information

NPI: 1528805934
Provider Name (Legal Business Name): KEVIN MICHAEL MURPHY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 90TH ST FL 3
DALY CITY CA
94015-1879
US

IV. Provider business mailing address

1303 SAN CARLOS AVE
SAN CARLOS CA
94070-2317
US

V. Phone/Fax

Practice location:
  • Phone: 650-877-5700
  • Fax: 650-877-5701
Mailing address:
  • Phone: 650-394-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number156115
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: