=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881540433
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN MURRAY
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2026
-----------------------------------------------------
Last Update Date | 03/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 131 WERTZ AVE NW
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44708-4171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 234-214-8470
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2314 TUSCARAWAS ST E
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44707-2749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 234-425-4675
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number | PRS.007542
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------