Basic Information
Provider Information
NPI: 1700429198
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MURPHY
FirstName: PATRICK
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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Mailing Information
Address1: 3205 N ACADEMY BLVD
Address2:  
City: COLORADO SPRINGS
State: CO
PostalCode: 809175147
CountryCode: US
TelephoneNumber: 7193447158
FaxNumber:  
Practice Location
Address1: 4863 N NEVADA AVE
Address2:  
City: COLORADO SPRINGS
State: CO
PostalCode: 809183951
CountryCode: US
TelephoneNumber: 7196325700
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/18/2019
LastUpdateDate: 10/18/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XCSW.09926041COY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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