Provider Demographics
NPI:1962805556
Name:MORRISON, JEANNIE WALULA (BCBA)
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:WALULA
Last Name:MORRISON
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 GREEN RIVER RD SUITE 105 # 2093
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-7433
Mailing Address - Country:US
Mailing Address - Phone:800-245-8705
Mailing Address - Fax:
Practice Address - Street 1:2621 GREEN RIVER RD SUITE 105 # 2093
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-7433
Practice Address - Country:US
Practice Address - Phone:800-245-8705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-10173103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-14-10173OtherBCBA