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General NPI Number Information
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NPI Number | 1912593260
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Entity Type | Individual
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Provider Name | MIATA MURPHY
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Gender | Female
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Dates
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Enumeration Date | 12/21/2020
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 2222 W GRAND RIVER AVE STE A
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City | OKEMOS
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State | MI
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Zip | 48864-1604
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Country | US
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Telephone | 248-238-8141
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Fax |
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Provider Business Mailing Address
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Address Line | 17765 MANDERSON RD APT 1
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City | DETROIT
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State | MI
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Zip | 48203-4014
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Country | US
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Telephone | 419-450-2866
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401224489
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License Number State | MI
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