Provider Demographics
NPI:1093000598
Name:MORLEY, ALISA CHAMBERLAIN
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:CHAMBERLAIN
Last Name:MORLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 S 200 W STE 1
Mailing Address - Street 2:
Mailing Address - City:BLANDING
Mailing Address - State:UT
Mailing Address - Zip Code:84511-3923
Mailing Address - Country:US
Mailing Address - Phone:435-678-2992
Mailing Address - Fax:435-678-3116
Practice Address - Street 1:356 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLANDING
Practice Address - State:UT
Practice Address - Zip Code:84511-3830
Practice Address - Country:US
Practice Address - Phone:435-678-2992
Practice Address - Fax:435-678-3116
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
UT8311698-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other