Provider Demographics
NPI:1164662284
Name:MORRIS, LAY-NAH BLUE (PPC)
Entity Type:Individual
Prefix:
First Name:LAY-NAH
Middle Name:BLUE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2458 N 9TH ST LOT 72
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-1790
Mailing Address - Country:US
Mailing Address - Phone:307-760-6341
Mailing Address - Fax:
Practice Address - Street 1:2458 N 9TH ST LOT 72
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-1790
Practice Address - Country:US
Practice Address - Phone:307-760-6341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-460101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor