Healthcare Provider Details

I. General information

NPI: 1770496283
Provider Name (Legal Business Name): JOHN MURRAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9135 PISCATAWAY RD
CLINTON MD
20735-2549
US

IV. Provider business mailing address

3702 FLOYD CT
UPPER MARLBORO MD
20772-6843
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-3636
  • Fax:
Mailing address:
  • Phone: 571-217-7047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP18562
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: