MEDICARE: MRS. KRYSTAL LEIGH MURPHY LCAS, MA

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	1855	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1855	OTHER	NC	LICENSED CLINICAL ADDICTION SPECIALIST

General Provider Information

NPI Number	:	1407150964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRYSTAL LEIGH MURPHY LCAS, MA

Provider Business Mailing Address
First Line	:	3110 ARENDELL ST
Second Line	:	SUITE 4
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-6511
Country	:	US
Telephone Number	:	252-727-5488
Fax Number	:	252-727-5302

Provider Business Practice Location Address
First Line	:	3110 ARENDELL ST
Second Line	:	SUITE 4
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-6511
Country	:	US
Telephone Number	:	252-727-5488
Fax Number	:	252-727-5302

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2010
Last Update Date	:	11/02/2012

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