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General NPI Number Information
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NPI Number | 1659719086
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Entity Type | Individual
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Provider Name | MISTY DAWN MURRAY TLBA
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Gender | Female
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Dates
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Enumeration Date | 06/07/2013
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Last Update Date | 09/26/2018
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Provider Practice Location Address
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Address Line | 303 SECOND ST
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City | SOMERSET
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State | KY
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Zip | 42501-2390
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Country | US
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Telephone | 606-677-1166
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Fax |
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Provider Business Mailing Address
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Address Line | 282 HAZELWOOD RD
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City | ANNVILLE
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State | KY
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Zip | 40402-9075
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Country | US
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Telephone | 606-364-2126
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | 201136144
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 244267
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License Number State | KY
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