Provider Demographics
NPI:1760634307
Name:MORRIS, JEAN MARIE (LAC)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MARIE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1611 S. PACIFIC COAST HIGHWAY
Mailing Address - Street 2:SUITE 308
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5614
Mailing Address - Country:US
Mailing Address - Phone:310-529-4554
Mailing Address - Fax:310-540-1692
Practice Address - Street 1:1611 S. PACIFIC COAST HIGHWAY
Practice Address - Street 2:SUITE #308
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5614
Practice Address - Country:US
Practice Address - Phone:310-529-4554
Practice Address - Fax:310-540-1692
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9913171100000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist