Provider Demographics
NPI:1104076827
Name:MURRAY, KATHLEEN T (PHD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:T
Last Name:MURRAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 W MAIN ST
Mailing Address - Street 2:STE 208
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2503
Mailing Address - Country:US
Mailing Address - Phone:479-530-7003
Mailing Address - Fax:641-682-1924
Practice Address - Street 1:226 W MAIN ST
Practice Address - Street 2:STE 208
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2503
Practice Address - Country:US
Practice Address - Phone:479-530-7003
Practice Address - Fax:641-682-1924
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR01-09P103TC0700X
IA001083103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1659353670Medicaid
IA1659353670OtherBLUE CROSS BLUE SHIELD OF IOWA
IAIB2309Medicare PIN