Provider Demographics
NPI:1295882298
Name:MCKETTY, MARCIA MURRAY (LMHC)
Entity type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:MURRAY
Last Name:MCKETTY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12044 RISING OAKS DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-0845
Mailing Address - Country:US
Mailing Address - Phone:904-292-1732
Mailing Address - Fax:
Practice Address - Street 1:3027 SAN DIEGO RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3691
Practice Address - Country:US
Practice Address - Phone:904-493-7759
Practice Address - Fax:904-348-2818
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8493101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health