Provider Demographics
NPI:1083213169
Name:MORRIS, COREY MARIE (MED, QMHS)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:MARIE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MED, QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27193 BAGLEY RD
Mailing Address - Street 2:
Mailing Address - City:OLMSTED TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44138-1061
Mailing Address - Country:US
Mailing Address - Phone:440-567-4009
Mailing Address - Fax:
Practice Address - Street 1:3518 W 25TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1951
Practice Address - Country:US
Practice Address - Phone:162-741-2241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2002657-TRNE101YM0800X
251S00000X
OHW.2300360251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHW.2300360Medicaid
OH1083213169Medicaid