Provider Demographics
NPI:1114044377
Name:MORRIS, NICOLE LOUISE (MFC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LOUISE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2626 ST. JOE CENTER RD.
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825
Mailing Address - Country:US
Mailing Address - Phone:260-497-0328
Mailing Address - Fax:604-970-9042
Practice Address - Street 1:2626 ST. JOE CENTER RD.
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825
Practice Address - Country:US
Practice Address - Phone:260-497-0328
Practice Address - Fax:260-497-0904
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46802106H00000X
IN35002099A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist