Provider Demographics
NPI:1285874552
Name:MORRIS, MICHAEL DURELL (MED)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DURELL
Last Name:MORRIS
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7332 W GLASS LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7008
Mailing Address - Country:US
Mailing Address - Phone:602-989-3986
Mailing Address - Fax:
Practice Address - Street 1:3333 W ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-3403
Practice Address - Country:US
Practice Address - Phone:602-764-3021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3494495101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool