=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124326582
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSIETTA S. MURRAY LCDC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2011
-----------------------------------------------------
Last Update Date | 03/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6103 SHADOW ISLE LN
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77084-6799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-289-7565
-----------------------------------------------------
Fax | 832-289-7565
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6103 SHADOW ISLE LN
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77084-6799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-289-7565
-----------------------------------------------------
Fax | 832-289-7565
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 9550
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------