Basic Information
| Provider Information | |||||||||
| NPI: | 1689046849 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURPHY | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4040 MEMORIAL PKWY SW | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358024364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565331970 | ||||||||
| FaxNumber: | 2567056477 | ||||||||
| Practice Location | |||||||||
| Address1: | 4040 MEMORIAL PKWY SW | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358024364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565331970 | ||||||||
| FaxNumber: | 2567056477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2015 | ||||||||
| LastUpdateDate: | 10/17/2016 | ||||||||
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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 | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 330000014 | 05 | AL | MEDICAID |