Provider Demographics
NPI:1013581578
Name:MORRISON, POLA GALAN (LEP #2652)
Entity Type:Individual
Prefix:
First Name:POLA
Middle Name:GALAN
Last Name:MORRISON
Suffix:
Gender:F
Credentials:LEP #2652
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4356 EARNEY RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-5600
Mailing Address - Country:US
Mailing Address - Phone:801-472-3719
Mailing Address - Fax:
Practice Address - Street 1:4356 EARNEY RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-5600
Practice Address - Country:US
Practice Address - Phone:801-472-3719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2652103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool