Provider Demographics
NPI:1164975181
Name:MORRIS, MELLONEE LARUTH (DAVIS)
Entity Type:Individual
Prefix:
First Name:MELLONEE
Middle Name:LARUTH
Last Name:MORRIS
Suffix:
Gender:F
Credentials:DAVIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-8395
Mailing Address - Country:US
Mailing Address - Phone:928-329-5855
Mailing Address - Fax:
Practice Address - Street 1:1595 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4706
Practice Address - Country:US
Practice Address - Phone:928-329-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator