Provider Demographics
NPI:1205261542
Name:MURROW, BRENDA L (PHD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:MURROW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 HAPPY HOLLOW ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:KS
Mailing Address - Zip Code:66544-8633
Mailing Address - Country:US
Mailing Address - Phone:303-507-3131
Mailing Address - Fax:
Practice Address - Street 1:406 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66508-1496
Practice Address - Country:US
Practice Address - Phone:785-562-3907
Practice Address - Fax:785-562-3930
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2533101Y00000X, 103TC0700X
225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201129860AMedicaid