Provider Demographics
NPI:1699551804
Name:MURPHY, TIONNA L (MED, CIT)
Entity type:Individual
Prefix:
First Name:TIONNA
Middle Name:L
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MED, CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 KEENELAND CT
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-3350
Mailing Address - Country:US
Mailing Address - Phone:314-817-8375
Mailing Address - Fax:
Practice Address - Street 1:3633 MARIETTA DR STE C
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-3208
Practice Address - Country:US
Practice Address - Phone:314-817-8375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty