Provider Demographics
NPI:1437689601
Name:MORRIS, JACQUELYN (MS, RMHCI)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MS, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 NW WESLEY RD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3752
Mailing Address - Country:US
Mailing Address - Phone:269-325-3660
Mailing Address - Fax:
Practice Address - Street 1:6041 NW WESLEY RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3752
Practice Address - Country:US
Practice Address - Phone:269-325-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15475101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health