Provider Demographics
NPI:1588094809
Name:MURPHY, KATHERINE WHITMIRE (MA, LPCC, LADC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:WHITMIRE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MA, LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6542 REGENCY LN STE 204
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7848
Mailing Address - Country:US
Mailing Address - Phone:612-230-8259
Mailing Address - Fax:
Practice Address - Street 1:6542 REGENCY LN STE 204
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7848
Practice Address - Country:US
Practice Address - Phone:612-230-8259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303444101YA0400X
MN1365101YP2500X
MNCC01365101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1588094809Medicaid