Provider Demographics
NPI:1972303568
Name:MCMURTRY, MICHELLE SUZETTE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SUZETTE
Last Name:MCMURTRY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 19TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-1993
Mailing Address - Country:US
Mailing Address - Phone:916-354-6266
Mailing Address - Fax:
Practice Address - Street 1:2012 19TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-1993
Practice Address - Country:US
Practice Address - Phone:916-354-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15434101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health