Provider Demographics
NPI:1285997643
Name:MORRISROE, SALLY B (LCPC)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:B
Last Name:MORRISROE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1819
Mailing Address - Country:US
Mailing Address - Phone:208-284-0365
Mailing Address - Fax:208-344-6461
Practice Address - Street 1:612 SCOTT ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1819
Practice Address - Country:US
Practice Address - Phone:208-284-0365
Practice Address - Fax:208-344-6461
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health