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NPI Code Detail

MEDICARE: MICHAEL BRODERICK MURPHY JR. M.S., LPC

MEDICARE: MICHAEL BRODERICK MURPHY JR. M.S., LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor86917TX

General Provider Information

NPI Number : 1205547379
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL BRODERICK MURPHY JR. M.S., LPC
Provider Business Mailing Address
First Line : 6150 VICKERY BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75214-3344
Country : US
Telephone Number : 203-610-9629
Fax Number :
Provider Business Practice Location Address
First Line : 5710 LYNDON B JOHNSON FWY STE 165
Second Line :
City : DALLAS
State : TX
Zip : 75240-6572
Country : US
Telephone Number : 203-610-9629
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2022
Last Update Date : 04/25/2024

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