Provider Demographics
NPI:1164921318
Name:MORRIS, TAMMY M (LCDCII)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:M
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LCDCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 OAKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-2191
Mailing Address - Country:US
Mailing Address - Phone:330-296-2384
Mailing Address - Fax:330-296-2466
Practice Address - Street 1:4771 WASHINGTON AVE.
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266
Practice Address - Country:US
Practice Address - Phone:330-296-2384
Practice Address - Fax:330-296-2466
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH121056101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)