Healthcare Provider Details

I. General information

NPI: 1710078324
Provider Name (Legal Business Name): MARTHA A MCMURRY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 EAST MAIN ST.
PARK HILLS MO
63601
US

IV. Provider business mailing address

512 E MAIN ST
PARK HILLS MO
63601-2624
US

V. Phone/Fax

Practice location:
  • Phone: 573-431-3341
  • Fax: 573-431-6580
Mailing address:
  • Phone: 573-431-6580
  • Fax: 573-431-6580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001430
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: