Provider Demographics
NPI:1841214137
Name:MORRIS, KIMBERLY YVETTE (PHD, HSPP)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:YVETTE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:YVETTE
Other - Last Name:ANGLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, HSPP
Mailing Address - Street 1:10330 N MERIDIAN ST # 300
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1907 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901
Practice Address - Country:US
Practice Address - Phone:765-456-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042072A103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11548839OtherCAQH ID NUMBER
IN000000386774OtherANTHEM BX/BS ID NUMBER
INMORRI-2007OtherCOMPCARE ID NUMBER
IN2172863OtherVALUE OPTIONS ID NUMBER