Healthcare Provider Details

I. General information

NPI: 1740962794
Provider Name (Legal Business Name): BRUCE LYNAIL MURRAY JR. BEHAVIOR TECHNICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRUCE LYNAIL MURRAY JR. BEHAVIOR TECHNICIAN

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DUNWOODY PARK STE 220
ATLANTA GA
30338-7404
US

IV. Provider business mailing address

1 DUNWOODY PARK STE 220
ATLANTA GA
30338-7404
US

V. Phone/Fax

Practice location:
  • Phone: 470-702-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: