Provider Demographics
NPI:1558517755
Name:MORRISON, COLLEEN JONELLE
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:JONELLE
Last Name:MORRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:JONELLE
Other - Last Name:MORRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:655 BAKER ST
Mailing Address - Street 2:APT. D106
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4435
Mailing Address - Country:US
Mailing Address - Phone:714-852-1164
Mailing Address - Fax:
Practice Address - Street 1:3188 AIRWAY AVE
Practice Address - Street 2:UNIT F
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4652
Practice Address - Country:US
Practice Address - Phone:714-689-1380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health