Healthcare Provider Details

I. General information

NPI: 1104788504
Provider Name (Legal Business Name): TIYAHNA CARTER-MURRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11315 CORPORATE BLVD STE 105
ORLANDO FL
32817-8340
US

IV. Provider business mailing address

4913 BIRCH STONE LN
ORLANDO FL
32829-8234
US

V. Phone/Fax

Practice location:
  • Phone: 407-534-0186
  • Fax:
Mailing address:
  • Phone: 407-534-0186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: