Provider Demographics
NPI:1962875211
Name:MURDOCK, JOSHUA
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:MURDOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 E GEORGIA AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3901
Mailing Address - Country:US
Mailing Address - Phone:318-242-0730
Mailing Address - Fax:318-242-0750
Practice Address - Street 1:829 E GEORGIA AVE STE 3
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270
Practice Address - Country:US
Practice Address - Phone:318-242-0730
Practice Address - Fax:318-242-0750
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA119681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator