MEDICARE: KAANN MURRAY MA, BCBA

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	103K00000X	Behavior Analyst	1-21-56666	SC

General Provider Information

NPI Number	:	1679234785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAANN MURRAY MA, BCBA

Provider Business Mailing Address
First Line	:	126 CO OP RD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7375
Country	:	US
Telephone Number	:	843-605-0107
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 CO OP RD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7375
Country	:	US
Telephone Number	:	843-605-0107
Fax Number	:

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

Provider Enumeration Date	:	01/02/2022
Last Update Date	:	01/30/2022

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