Provider Demographics
NPI:1649462862
Name:MURRAY, KELLY MARTIN (PHD)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MARTIN
Last Name:MURRAY
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 1:1892 WILLAMETTE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4044
Mailing Address - Country:US
Mailing Address - Phone:541-345-0766
Mailing Address - Fax:
Practice Address - Street 1:1892 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4044
Practice Address - Country:US
Practice Address - Phone:541-345-8505
Practice Address - Fax:541-345-8810
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-11
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR2058103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health