Basic Information
| Provider Information | |||||||||
| NPI: | 1487107397 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURRAY | ||||||||
| FirstName: | KELLI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5671 N SKEEL AVE | ||||||||
| Address2: | |||||||||
| City: | OSCODA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487501535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897392550 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5671 N SKEEL AVE | ||||||||
| Address2: | |||||||||
| City: | OSCODA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487501535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897392550 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2016 | ||||||||
| LastUpdateDate: | 09/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.