Provider Demographics
NPI:1851825590
Name:MCMORRIS, CHARLISS
Entity type:Individual
Prefix:
First Name:CHARLISS
Middle Name:
Last Name:MCMORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7636 IRONWOOD CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-3029
Mailing Address - Country:US
Mailing Address - Phone:612-986-9756
Mailing Address - Fax:
Practice Address - Street 1:2735 S MENDENHALL RD
Practice Address - Street 2:SUITE 8
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-1556
Practice Address - Country:US
Practice Address - Phone:612-986-9756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YP1600X101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral