Provider Demographics
NPI:1558539510
Name:MORRIS, TAMMY
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5490 BROADWAY
Mailing Address - Street 2:L3
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-1663
Mailing Address - Country:US
Mailing Address - Phone:219-985-6170
Mailing Address - Fax:219-985-6097
Practice Address - Street 1:5490 BROADWAY
Practice Address - Street 2:L3
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-1663
Practice Address - Country:US
Practice Address - Phone:219-985-6170
Practice Address - Fax:219-985-6097
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200037730Medicaid