Provider Demographics
NPI:1629298351
Name:MORRIS, BRENDA (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1712
Mailing Address - Country:US
Mailing Address - Phone:502-627-0905
Mailing Address - Fax:502-208-1058
Practice Address - Street 1:1190 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1712
Practice Address - Country:US
Practice Address - Phone:502-627-0905
Practice Address - Fax:502-208-1058
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5439122300000X
KY163380103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No122300000XDental ProvidersDentist