Healthcare Provider Details

I. General information

NPI: 1649462862
Provider Name (Legal Business Name): KELLY MARTIN MURRAY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2007
Last Update Date: 04/06/2024
Certification Date: 04/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1892 WILLAMETTE ST
EUGENE OR
97401-4044
US

IV. Provider business mailing address

1892 WILLAMETTE ST
EUGENE OR
97401-4044
US

V. Phone/Fax

Practice location:
  • Phone: 541-345-8505
  • Fax: 541-345-8810
Mailing address:
  • Phone: 541-345-0766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2058
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: