Provider Demographics
NPI:1841590916
Name:MORRIS, KELLY LEA (LAC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LEA
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LEA
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2301 W DUNLAP AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2844
Mailing Address - Country:US
Mailing Address - Phone:602-750-8051
Mailing Address - Fax:602-674-5701
Practice Address - Street 1:2301 W DUNLAP AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2844
Practice Address - Country:US
Practice Address - Phone:602-750-8051
Practice Address - Fax:602-674-5701
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-12640101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional