Provider Demographics
NPI:1962992560
Name:MURPHY, KELLIE S (MA, ATR, LPC)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:S
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MA, ATR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7402 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3106
Mailing Address - Country:US
Mailing Address - Phone:608-347-3587
Mailing Address - Fax:
Practice Address - Street 1:6502 GRAND TETON PLZ STE 204
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719
Practice Address - Country:US
Practice Address - Phone:608-347-3587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2560101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional