Provider Demographics
NPI:1891734091
Name:MORRIS, JEREMY DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:DAVID
Last Name:MORRIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 HOLLY LANE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401
Mailing Address - Country:US
Mailing Address - Phone:785-452-4930
Mailing Address - Fax:785-452-4932
Practice Address - Street 1:730 HOLLY LANE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401
Practice Address - Country:US
Practice Address - Phone:785-452-4930
Practice Address - Fax:785-452-4932
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1370103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200372590AMedicaid
KSQ68248Medicare UPIN