Provider Demographics
NPI:1366726614
Name:MURRAY, BRONWYN (PSYD)
Entity type:Individual
Prefix:
First Name:BRONWYN
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 W MOSLEY ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-4970
Mailing Address - Country:US
Mailing Address - Phone:734-845-4361
Mailing Address - Fax:
Practice Address - Street 1:514 E WILLIAM ST
Practice Address - Street 2:SUITE A
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2446
Practice Address - Country:US
Practice Address - Phone:734-845-4361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014636103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral