Provider Demographics
NPI:1699300558
Name:CHAUNCEY MURCH LLC
Entity type:Organization
Organization Name:CHAUNCEY MURCH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAUNCEY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MURCH
Authorized Official - Suffix:III
Authorized Official - Credentials:LPC, NCC, BC-TMH
Authorized Official - Phone:918-212-6333
Mailing Address - Street 1:1626 CHAUTAUQUA AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-6343
Mailing Address - Country:US
Mailing Address - Phone:918-212-6333
Mailing Address - Fax:
Practice Address - Street 1:1626 CHAUTAUQUA AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-6343
Practice Address - Country:US
Practice Address - Phone:918-212-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200898110AMedicaid