1912006164 NPI number — MRS. LISA ANN MURRAY LPC LIC PROF COUNS

Table of content: MRS. LISA ANN MURRAY LPC LIC PROF COUNS (NPI 1912006164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912006164 NPI number — MRS. LISA ANN MURRAY LPC LIC PROF COUNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURRAY
Provider First Name:
LISA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC LIC PROF COUNS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARTLEY
Provider Other First Name:
LISA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912006164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13614 DRAKEWOOD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-279-5472
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
94 BRIGGS AVENUE
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-923-0580
Provider Business Practice Location Address Fax Number:
210-923-2616
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  18262 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7516LC . This is a "BCBS OUT OF NETWK PROV" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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