Provider Demographics
NPI:1073270005
Name:MORSE, DEE DEE MAY JADE (MED)
Entity Type:Individual
Prefix:
First Name:DEE DEE MAY
Middle Name:JADE
Last Name:MORSE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 N LAKE AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-3743
Mailing Address - Country:US
Mailing Address - Phone:661-623-6790
Mailing Address - Fax:
Practice Address - Street 1:21363 LASSEN ST STE 202
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-4274
Practice Address - Country:US
Practice Address - Phone:818-909-2253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-21-53189103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty