Provider Demographics
NPI:1447578703
Name:MORLETT, CONNIE (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:
Last Name:MORLETT
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9831 VAIL DR
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2865
Mailing Address - Country:US
Mailing Address - Phone:714-252-3360
Mailing Address - Fax:714-464-4111
Practice Address - Street 1:250 W 1ST ST
Practice Address - Street 2:STE 214
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4736
Practice Address - Country:US
Practice Address - Phone:714-252-3360
Practice Address - Fax:714-464-4111
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88711106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47-5044943Medicare UPIN