Basic Information
| Provider Information | |||||||||
| NPI: | 1073917282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURRELL | ||||||||
| FirstName: | LYANA | ||||||||
| MiddleName: | MONIQUE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | ACSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 E 12TH ST | ||||||||
| Address2: | SUITE 259 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946013424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102699030 | ||||||||
| FaxNumber: | 5102699031 | ||||||||
| Practice Location | |||||||||
| Address1: | 3301 E 12TH ST | ||||||||
| Address2: | SUITE 259 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946013424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102699030 | ||||||||
| FaxNumber: | 5102699031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2014 | ||||||||
| LastUpdateDate: | 04/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | ASW70693 | CA | N | Behavioral Health & Social Service Providers | Counselor | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.