Provider Demographics
NPI:1578898334
Name:MORRISEY, MARY L (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:L
Last Name:MORRISEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 N COLE RD
Mailing Address - Street 2:#255
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5964
Mailing Address - Country:US
Mailing Address - Phone:208-376-0453
Mailing Address - Fax:
Practice Address - Street 1:2995 N COLE RD
Practice Address - Street 2:#255
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5964
Practice Address - Country:US
Practice Address - Phone:208-376-0453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-3612101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1093844474OtherBLUE CROSS OF IDAHO
ID1093844474OtherBLUE SHIELD OF IDAHO