Provider Demographics
NPI:1063182764
Name:MANCHESTER -MURPHY, ELIZABETH JACK (LSP,LMHC, ACAS)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JACK
Last Name:MANCHESTER -MURPHY
Suffix:
Gender:F
Credentials:LSP,LMHC, ACAS
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:JACK
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACAS,LSP,LMHC
Mailing Address - Street 1:23160 FASHION DR STE 217
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-2567
Mailing Address - Country:US
Mailing Address - Phone:239-378-6755
Mailing Address - Fax:239-790-0975
Practice Address - Street 1:23160 FASHION DR STE 217
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-2567
Practice Address - Country:US
Practice Address - Phone:393-786-7552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23711101YM0800X
FL23711101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH27311OtherLMHC
FL1861220766OtherPRACTICE NPI