Provider Demographics
NPI:1992817464
Name:MORRIS, WILBERT WAYNE (MA/LLP)
Entity type:Individual
Prefix:MR
First Name:WILBERT
Middle Name:WAYNE
Last Name:MORRIS
Suffix:
Gender:M
Credentials:MA/LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-1704
Mailing Address - Country:US
Mailing Address - Phone:810-364-0783
Mailing Address - Fax:
Practice Address - Street 1:2875 HENRY ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-2526
Practice Address - Country:US
Practice Address - Phone:810-966-3575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011066103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM97230007Medicare ID - Type Unspecified