Provider Demographics
NPI:1922313311
Name:MORRIS, STEPHANIE MALYN (LCSW, CRADC, ICADC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MALYN
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LCSW, CRADC, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:64075-0252
Mailing Address - Country:US
Mailing Address - Phone:816-267-3303
Mailing Address - Fax:660-259-9127
Practice Address - Street 1:113 S 13 HWY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1401
Practice Address - Country:US
Practice Address - Phone:660-259-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2200101YA0400X
MO20070016861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)