Basic Information
| Provider Information | |||||||||
| NPI: | 1235389016 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MURPHY | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | DIANE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 SUTTLE ST. | ||||||||
| Address2: | ATTN: AXIS HEALTH CENTER-CREDENTIALING | ||||||||
| City: | DURANGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813038276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703352232 | ||||||||
| FaxNumber: | 9705659005 | ||||||||
| Practice Location | |||||||||
| Address1: | 281 SAWYER DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DURANGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813033409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703853491 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2008 | ||||||||
| LastUpdateDate: | 10/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 09923178 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.