Provider Demographics
NPI:1194966895
Name:MORRILL, LAUREL EVELYN (LCSW)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:EVELYN
Last Name:MORRILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9706 JACKSON HTS
Mailing Address - Street 2:
Mailing Address - City:HARSHAW
Mailing Address - State:WI
Mailing Address - Zip Code:54529-9625
Mailing Address - Country:US
Mailing Address - Phone:208-961-1477
Mailing Address - Fax:
Practice Address - Street 1:9706 JACKSON HTS
Practice Address - Street 2:
Practice Address - City:HARSHAW
Practice Address - State:WI
Practice Address - Zip Code:54529-9625
Practice Address - Country:US
Practice Address - Phone:208-961-1477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID104100000X
WI83061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical