Provider Demographics
NPI:1568534659
Name:MORRISON, BARRY A (MED)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:A
Last Name:MORRISON
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 GRAVOIS RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-4122
Mailing Address - Country:US
Mailing Address - Phone:314-757-1170
Mailing Address - Fax:
Practice Address - Street 1:320 GRAVOIS RD
Practice Address - Street 2:SUITE F
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-4122
Practice Address - Country:US
Practice Address - Phone:314-757-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000143571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202055OtherANTHEM BCBS OF MO