MEDICARE: MARY MURRAY L.P.C, C.A.C.II

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	7284	CO
2	101YP2500X	Professional Counselor	5269	CO

General Provider Information

NPI Number	:	1962830976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MURRAY L.P.C, C.A.C.II

Provider Business Mailing Address
First Line	:	6343 W 120TH AVE STE 105
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80020-3701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1632 WANEKA LAKE TRL
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-1272
Country	:	US
Telephone Number	:	303-665-3833
Fax Number	:

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

Provider Enumeration Date	:	10/30/2013
Last Update Date	:	10/30/2013

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