Provider Demographics
NPI:1063277655
Name:MURRAY, STACY NICOLE
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:NICOLE
Last Name:MURRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4958 W HERNDON AVE APT 109
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-8429
Mailing Address - Country:US
Mailing Address - Phone:559-765-9475
Mailing Address - Fax:
Practice Address - Street 1:4958 W HERNDON AVE APT 109
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-8429
Practice Address - Country:US
Practice Address - Phone:559-765-9475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician