Provider Demographics
NPI:1982614798
Name:MORRISON, MARK ALAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALAN
Last Name:MORRISON
Suffix:
Gender:M
Credentials:LCSW
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Mailing Address - Street 1:1035 W GLEN OAKS LN STE 110
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3392
Mailing Address - Country:US
Mailing Address - Phone:262-244-6177
Mailing Address - Fax:262-299-3040
Practice Address - Street 1:11518 N PORT WASHINGTON RD STE 202
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3443
Practice Address - Country:US
Practice Address - Phone:847-962-7917
Practice Address - Fax:262-299-3040
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI42521231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43742200Medicaid