Provider Demographics
NPI:1225132673
Name:MORRISON, MICHAEL MCKIM (MA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:MCKIM
Last Name:MORRISON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17772 IRVINE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3256
Mailing Address - Country:US
Mailing Address - Phone:714-669-1783
Mailing Address - Fax:714-669-1783
Practice Address - Street 1:17772 IRVINE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3256
Practice Address - Country:US
Practice Address - Phone:714-669-1783
Practice Address - Fax:714-669-1783
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34279106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist