Healthcare Provider Details

I. General information

NPI: 1972875839
Provider Name (Legal Business Name): MISTY CHEYANNE MURPHY MFT INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3132 JEFFERSON ST
SAN DIEGO CA
92110-4421
US

IV. Provider business mailing address

3132 JEFFERSON ST
SAN DIEGO CA
92110-4421
US

V. Phone/Fax

Practice location:
  • Phone: 619-683-3100
  • Fax:
Mailing address:
  • Phone: 619-683-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: