Healthcare Provider Details

I. General information

NPI: 1881096451
Provider Name (Legal Business Name): MERRILL MURPHY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 OAK AVE
MUSKEGON MI
49442-2468
US

IV. Provider business mailing address

1611 OAK AVE
MUSKEGON MI
49442-2468
US

V. Phone/Fax

Practice location:
  • Phone: 231-767-1921
  • Fax: 231-767-0527
Mailing address:
  • Phone: 231-767-1921
  • Fax: 231-767-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401017118
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: