Provider Demographics
NPI:1477675619
Name:MORROW, DERYL DION
Entity Type:Individual
Prefix:MR
First Name:DERYL
Middle Name:DION
Last Name:MORROW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HUDDLESON ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1728
Mailing Address - Country:US
Mailing Address - Phone:505-920-7474
Mailing Address - Fax:
Practice Address - Street 1:120 HUDDLESON ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1728
Practice Address - Country:US
Practice Address - Phone:505-920-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor