Provider Demographics
NPI:1407493190
Name:MORRIS, JULIE LYNN (LLC)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:LYNN
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 RIVERVIEW DR # B
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-1851
Mailing Address - Country:US
Mailing Address - Phone:602-434-5256
Mailing Address - Fax:
Practice Address - Street 1:1215 RIVERVIEW DR # B
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-1851
Practice Address - Country:US
Practice Address - Phone:602-434-5256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA83-2943230Other83-2943230