Provider Demographics
NPI:1922352046
Name:MORRISS, MATT
Entity Type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:MORRISS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 E 450 S
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1736
Mailing Address - Country:US
Mailing Address - Phone:801-779-2253
Mailing Address - Fax:
Practice Address - Street 1:446 E 450 S
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1736
Practice Address - Country:US
Practice Address - Phone:801-779-2253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health