Provider Demographics
NPI:1235448499
Name:MORRIS, SANDRA K (MA, LLP)
Entity Type:Individual
Prefix:MR
First Name:SANDRA
Middle Name:K
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 S WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-3799
Mailing Address - Country:US
Mailing Address - Phone:616-834-5648
Mailing Address - Fax:
Practice Address - Street 1:348 S WAVERLY RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3799
Practice Address - Country:US
Practice Address - Phone:616-229-4749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014526103TC1900X
MI6361001135101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6361001135OtherSTATE OF MICHIGAN