Provider Demographics
NPI:1972006187
Name:MORRIS, KATELYNN ONIE ASHLEY
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:ONIE ASHLEY
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ONIE ASHLEY
Other - Last Name:DEPEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1015 LOIS AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-1845
Mailing Address - Country:US
Mailing Address - Phone:386-336-3193
Mailing Address - Fax:
Practice Address - Street 1:4942 HIGBEE AVE NW STE C&B
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2554
Practice Address - Country:US
Practice Address - Phone:330-491-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 106S00000X
OHS.2106923104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSMedicaid